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IN SEARCH OF THE SOUL AND THE MECHANISM OF THOUGHT, EMOTION, AND CONDUCT A Treatise in Two Volumes CONTAINING A BRIEF BUT COMPREHENSIVE HISTORY OF THE Philosophical Speculations and Scientific Researches FROM ancient TIMES TO THE PRESENT DAY AS WILL AS AN ORIGINAL ATTEMPT To Account for the Mind and Character of Man AND establish THE PRINCIPLES OF A SCIENCE OF ETHOLOGY VOLUME II The Origin of the MENTAL CAPACITIES and DISPOSITIONS of Man and their Normal, Abnormal and Supernormal Manifestations By BERNARD HOLLANDER, M.D. Author of The Mental Functions of the Brain, Mental Symptoms of Brain Disease, The First Signs of Insanity, Nervous Disorders of Men, Nervous Disorders of Women, Abnormal Children, Hypnotism and Suggestion, etc. London : KEGAN PAUL, TRENCH, TRUBNER & CO., LTD. NEW YORK: E. P. BUTTON & CO. r- ^ CONTENTS OF VOLUME II SECTION I ANALYSIS OF MAN'S PSYCHICAL NATURE FAGE CHAPTER XXV.— ETHOLOGY : THE SCIENCE OF CHARACTER - - I The Meaning of Character. Innate Potential Tendencies. The Origin of the Emotions. Emotions and Propensities versus Intellect. The Nature of Instinct. Animals and Intellect. The Will and the Power of Choice. CHAPTER XXVL— EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES .-.-.--. 21 Love of Life and the Propensity of Self-Protection. The Alimentary Propensity. The Combative Propensity and the Propensity of Resentment. The Emotion of Anger. The Pro- pensity TO TAKE Flight and the Emotion of Fear. The Pro- pensity to Conceal and the Feeling of Suspicion. The Propensity TO Acquire and Hoard. The Sexual Propensity. Parental AND Filial Love. Love of Home and Country. The Social Feelings. The Self-Regarding Sentiments. Love of Praise AND SeLF-EsTEEM. CHAPTER XXVIL— EVOLUTION OF THE INTELLECTUAL CAPACITIES AND THE ETHICAL, /ESTHETICAL, AND RELIGIOUS SENTIMENTS - 42 The Powers of Observation and Remembrance. The Memory of Words, Numbers, Time, Places, etc. The Reasoning Powers. Inductive and Deductive Meditation. Illusions, Hallucina- tions, and Delusions. Manual Dexterity and Constructive Capacity. The Power of Imitation. The .Esthetic Sense and the Feeling of the Sublime. The Altruistic Sentiments. The Moral Sense and Conscience. The Religious Sentiments : ^v!* Wonder, Awe, Veneration, F.\ith, etc. The Foundations of Religious Belief. .^ SECTION 11 THE MENTAL FUNCTIONS OF THE BRAIN CHAPTER XXVIIL— THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES ........ 6l I The Mental Functions of the Brain. Size of Brain and Mental y Power. Size of Brain and Bulk of Body. Brain Weights. ■.'J Multiplicity of Centres in the Brain : for Emotions and Pro- pensities AS WELL AS Intellect. Causes of Brain Lesion without Mental Change. Brain Tumours and Mental Changes. Im- portance of the Localisation Theory. Vi CONTENTS PAGE CHAPTER XXIX.— INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN ........ 89 Brain Centres for the Primary Intellectual Powers. An- thropological Data. Experimental Evidence. Pathological Evidence. Clinical Cases of Euphoria, Exaltation, and Moria ; with Cases of Recovery after Surgical Operation. Inhibitory Centres of the Brain and Morality. Clinical Cases of Loss of Moral Sense. The Perceptive Centres. General Faculty of Memory not Localisable. Clinical Cases of Loss of Special Memories ; with Cases of Recovery after Surgical Operation. Cases of Loss of Arithmetical Ability, Loss of Tone Sense (Musical Ability), etc. CHAPTER XXX.— THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 122 Fear and Melancholia. Anatomical and Physiological Con- siderations. Clinical Cases of Melancholia from Head Injury, Tumours, and Other Circumscribed Lesions ; with Cases of Recovery after Surgical Operation. Cases of Melanchoua with Psychical Blindness. CHAPTER XXXL— THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN J. ....-.- 146 Irascibility and Acute Mania. Clinical Cases of Acute Mania after Head Injury, Tumours, and Other Circumscribed Lesions ; with Cases of Recovery after Surgical Operation. Cases of Acute Mania with Sensory Aphasia. Mental Disturbances in Ear Disease. CHAPTER XXXII— OTHER PRIMARY MENTAL DISPOSITIONS AND THEIR CEREBRAL ORIGINS - - 169 Suspicion and its Cerebral Origin. Clinical Cases of Delusions of Suspicion and Persecution after Head Injury, Tumours, and other Circumscribed Lesions; with Cases of Recovery after Surgical Operation. Hunger and Thirst Centres. The Hoarding Propensity and its Probable Cerebral Origin. The Affections AND THEIR BrAIN CENTRES. ThE SeXUAL PROPENSITY AND ITS Cerebral Origin, SECTION III GENIUS, INSANITY, AND CRIME CHAPTER XXXIII —HEREDITY, EDUCATION, AND THE CHARACTERISTICS OF GENIUS -.----.. 199 Nature and Nurture. Only Potential Dispositions Inherited. Can Acquired Characters be Inherited ? Reaction to Environ- ment. The Function of Education. Causes of Backwardness. Moral Education. Plans for the Reform of Education. In- tellectual Gifts and Passions of Genius. Genius versus Talent, Self-made Men. The Brains of Men of Genius. Genius, Neurosis, AND Insanity. CHAPTER XXXIV— THE APPLICATION OF ETHOLOGY TO THE STUDY OF INSANITY .--.---- 222 Definition of Insanity. First Signs of Insanity. Derangement of Emotions before Derangement of the Intellect. The Etho- LOGicAL Study of the Varieties of Insanity. Asylum Reform. Observation Hospit.als. Idiocy, Imbecility, Feeble-Mindedness, AND Moral Weak-Mimdedness. CONTENTS vii PAQB CHAPTER XXXV.— THE ETHOLOGY OF THE CRIMINAL - - - 246 The " Will " to Crime. Responsibility. Ordinary, Accidental, Professional, Weak-Minded, Insane, and Semi-Insane Criminals. The Various Forms of Insanity in Relation to Crime. SECTION IV UNEXPLORED POWERS OF TNI MIND CHAPTER XXXVI.— THE POWER OF SUGGESTION - - - 264 Interaction of Mind and Brain. Subconsciousness. Universal Suggestibility. Auto-Suggestion. Methods of Suggestion. Ex- planation OF Hypnotism. Hypnosis and Sleep. The Nature of Dreams. Dissociated Personality and Treatment by Psycho- analysis. Suggestion in the Waking State and its Results. CHAPTER XXXVII— HISTORY AND RESULTS OF HYPNOTISM - - 281 History of Hypnotism. Accredited Phenomena of Experimental Hypnotism. Post-Hypnomc Results. Multiple Personality. CHAPTER XXXVIII— EXTRAORDINARY PHENOMENA. EVIDENCE OF UNEXPLORED FORCES AND CAPACITIES • - - •297 Reichenbach's Experiments. Magnetic Influences. N-Rays. The Sthenometer. Nervous Force. Human Aura. Experi- mental Production of Extraordinary Acuity of the Senses and General Sensibility Independent of Suggestion. Artificial Manifestation of Accentuated Mental Powers. Other Phenomena — Clairvoyance, Telepathy — and Their Explanation. Human Beings Endowed with Capacities Still Unexplored and Un- appreciated. CHAPTERXXXIX— THE SPIRITUAL NATURE OF MAN - - -317 The Limitations of Science. The Problem of "Life." Conscious- ness. The Nature of Mind, The Problem of Soul and Im- mortality. LIST OF NAIVIES 339 SUBJECT INDEX 351 SECTION I ANALYSIS OF MAN'S PSYCHICAL NATURE CHAPTER XXV ETHOLOGY : THE SCIENCE OF CHARACTER Having concluded the history of philosophy and science in Vol. I., the reader will now be prepared for the consideration of those problems which form the real subject-matter of this work. We propose to deal with them, in succession, as follows : (i) The mental organisation of man ; (2) The ph5rsical structure which serves for the manifestation of his intellectual capacities, emotional tendencies, and instinctive impulses ; and (3) The evidence for the existence of higher capacities in man which apparently are spiritual ; that is to say, for which, up to the present, no explanation has been found. THE SCIENCE OF CHARACTER AND CONDUCT We have seen that, notwithstanding some twenty-five centuries of philosophic speculation and more than two centuries of scientific research, we are still in ignorance of the nature of mind, of the varieties of mental activities, and the laws which govern them. One of the reasons for this lack of progress is that most psychologists until quite recently concerned themselves almost exclusively with consciousness, and the ideas and understanding of man, studying " thought " for its own sake, whereas the science of mind also embraces strivings and desires, feelings and action, i.e., character and conduct. The great problem of psychology through- out the ages has been : " Have we ideas independent of experience ? " But far more important is the question, so long ignored : " Have we desires independent of experience ? " The psychologist studied himself, by a method of introspection and self-analysis ; whereas the true mental philosopher studies his fellow-men and uses his powers of observation. The psychologist looked around his own mind-chamber, whereas the practical philosopher looks out upon the theatre of human life wherein all human beings are the actors. Each psychologist wrote long and most abstruse disquisitions upon the patent and latent errors of his eminent predecessors, besides giving the world speculations of his own ; but it is a lamentable testimony to the insufficiency of the method of psychology that, notwithstanding the number of its distinguished followers, the greatest thinkers that the world ever possessed, they had to hand over to poets, dramatists, and romance-writers the description of the fundamental facts of human nature and motives of conduct, and the problems that arise from them. Success in hfe depends largely on knowledge of the character of one's feUow-men ; but character cannot be studied by introspection. A successful business man knows Vol. ii.] B 2 ANALYSIS OF MAN'S PSYCHICAL NATURE more about it than is disclosed in our psychological text-books. No matter how much we may study ourselves, the knowledge of our own individuality will be of little use unless combined with the knowledge of the individuality of others. Mental phenomena do not lend themselves to self-observation like physical phenomena ; they are in a state of continual change. Wlien in a passion, we cannot stop and observe it ; for by reflection the emotion tends to be weakened, and may even disappear altogether. Moreover, the highly instructive study of mental disorders — the pathology of mind, to which we are about to contribute considerable material in this work — is altogether impossible by the method of self -introspection. To know one's self is a task attended with no small difficulty ; and to suppose that we can attain self-knowledge by mere consciousness is an error as great as it is fatal. Tke difficulty of this study was acknowledged by the ancients ; in fact, the attainment of self-knowledge was regarded by them as worthy the attention of the gods, requiring the highest exertion of the soul. " Know thyself," was a precept of THALES, the Milesian, who said : " That for a man to know himself is the hardest thing in the world." It acquired the authority of a divine oracle, and was written in gold letters over the door of the temple of Apollo, at Delphos. Indeed, Apollo was supposed to be its author ; because, as Cicero said, " it has such a weight of sense and wisdom in it as appears too great to be attributed to any man." A complete science of mind must include a science of character. Possibly one of the reasons why this subject has been neglected so long is that — as with religion and politics, so with human character — everyone claims to have a knowledge of it, and to be able to discourse upon it if called to do so. Yet just because everybody appears to know all that can be said about it, the subject has been treated only in a popular manner and has so far not been subjected to a scientific analysis. Human character from all time has been popularly studied, and all men may lay claim to a certain knowledge thereof ; but hitherto we have rested content with studying the actions of human beings, without searching for the hidden springs governing them. What is it that makes one man place liis happiness in the pos- session of riches, someone else in the gratification of his thirst for glory, or yet another in his desire to do good to his fellow-men ? Wliat is it that renders one man distinguished for his success in poetry, or music, or, mathematics or, say, statesman- ship ? Why is it that in all ages and throughout all countries robberies and murders have been committed, and neither education, legislation, religion, the prison, nor the gallows, have yet been able to extirpate these crimes ? Look at the large amount of domestic unhappiness from lack of a proper understanding of the character and motives of husband and wife ! Glance at the miseries of men whose career was determined by their parents against their natural inclinations and the consequent loss of brain capacity to the State ! Look at the crimes committed by persons in those early stages of mental derangement which none but an expert knows to be indicative of insanity ! Think over all these problems, and you will arrive at the conclusion that there is one subject of study which has hitherto been neglected, namely, the study of human character. There is no science which has up to now essayed to reveal, with anything hke completeness, the primary mental powers, or to demonstrate their modes of opera- tion, to account for the peculiar mental build of each individual or for the wide contrasts perceptible in the characteristics of nations. We have had abundance of fruitless speculations, but no scientific data ; and amid such lamentable deficiency how greatly have the interests of education, legislation, and morals suffered ! The diversity of opinions has in every age increased with the diversity of writers. Libraries are teeming with philosophical treatises, yet we are poor in the midst of such abounding riches, and have had no work on the science of character. It would appear that the ancient Greeks were closer students of what they called ETHOS, ETHOLOGY: THE SCIENCE OF CHARACTER 3 the heart or soul of man, which they held to be the seat of his intellect, feelings, desires and passions, than were the philosophers who succeeded them, not excluding even the great thinkers of the present day. Thousands of years have gone by and we have still no standard whereby to measure man. We have seen that GALL'S doctrine furnished the first rudiments of a science of character, but that doctrine was ignored, or condemned, by psychologists under the mistaken notion that it was akin to the faculty psychology. After him, JOHN STUART MILL, stimulated by Comte, a supporter of Gall (see Correspondence between Comte and Mill), drew attention to the necessity of a science of character. Later BAIN and SPENCER, as we have seen, worked more or less on Gall's lines ; but even Spencer paid more attention to perceptions and ideas than to feelings and action. It is only within quite recent years that a number of writers on so-called Social Psychology, without being aware of what had been done already in that direction by Gall's followers, have contributed a variety of books and papers on the subject of character and conduct ; to mention only Ribot, William James, Alexander Sutherland, McDougall, A. F. Shand, Charles Mercier, Harry Campbell, Drever, Mott, Hyslop, Armstrong- Jones, Parmelee, Coriat, Boris Sidis, Tanner, W. Trotter, J. B. Watson, etc. It was JOHN STUART MILL ("Logic," bk. vi., chap, v.) who first suggested the name ETHOLOGY for the scientific study of character. " A science is thus formed to which I would propose to give the name of Ethology, or the Science of Character, from ethos, a word more nearly corresponding to the term ' cliaracter,' as I use it here, than any other word in the same language. The name is perhaps etjinologically applicable to the entire science of our mental and moral nature ; but if, as is usual and convenient, we employ the name Psychology for the science of the elementary laws of mind, Ethology will serve for the ulterior science which determines the land of character produced in conformity to those general laws by any set of circumstances, physical and moral. According to this definition. Ethology is the science which corresponds to the act of education, in the widest sense of the term, including the formation of national or collective character as well as individual." Etymologically, the word ethos is applicable to the entire science of our mental and moral nature, and the scientific view^s of character should embrace the totaUty of all the mental and moral peculiarities : the intellectual abilities, judgment, imagination, the emotions, passions, animal propensities, moral virtues, the aesthetic, worldly, and religious Ufe and aspirations. Ethology is the science of Human Character and deals with human action or conduct. Of course, the basis of conduct is the reaction to environment. But all action or conduct is dictated by certain motives and springs from certain habits or dis- positions. A science of character, therefore, must be essentially a science of the motives of conduct — motive being that characteristic tendency or disposition of man in virtue of which a given act possesses an attraction for him. 1 The character of every man depends partly on innate potential dispositions and/ partly upon external circumstances. It is expressed, in the first place, by his mode of/ reaction to his environment according to his choice among his own innate or acquired tendencies — that is to say, the usual manner of his behaviour ; secondly, by the emotional energy of his actions, which may decline as habits are formed ; and, tliirdly, by the intelligence with which ends are comprehended and means ad j usted to them. The older psychologists did not admit the innateness of the primary motives of human conduct, but held that the sensation of pleasure or pain determines our actions. For example, according to BENTHAJVI, a motive is substantially nothing more than pleasure or pain operating in a certain manner. And according to LOCKE, 4 ANALYSIS OF MAN'S PSYCHICAL NATURE the feeling of pleasure or pain is the motive to action or inaction. We strive for riches because we recollect the pleasures which they can yield to us ; we are deterred by punishment because we recollect its pain. These are the motives which Utilitarian philosophy regards as the mainsprings of our conduct. They influence us very greatly ; but there are stronger forces, some of which lie beyond the appre- hension of our consciousness. Happiness, like health, is one of the things of which men rarely think except when it is lost. Most men are unconscious of their faculties until they become obstructed or impaired. The pleasure and pain theory does not account for actions of self-denial, nor for the actions arising from anger and fear. Furthermore, every emotion has a potential disinterestedness, so far as among the stimuli are some which excite it on behalf of another individual instead of on behalf of one's self. There are selfish emotions which are disinterested, as when an animal experiences the emotion of fear and sacrifices its own life to save that of its offspring. What is the fixed emotion of avarice ? Is it the joy of the avaricious man in the possession of his wealth, present in the thought of it, expressed in the handling of it ? This at least seems to be the centre of his passion in favourable circumstances, to which his activities converge. But suppose that he loses his wealth or a part of it ; or even that he fears to lose it. What becomes of his joy ? Is it replaced by sorrow or fear ? But if his passion is identical with joy, then it ceases to exist, because the joy felt in the possession of its object is replaced by sorrow at its loss or fear at its apprehended loss. On the contrary, the sorrow and the fear are both evidence of its continued existence. If the avaricious man did not feel them in the appropriate circumstances, he would not love his wealth. The same law is exemplified in the case of love of approbation. The enjoyment which it affords depends on its active state ; and the necessity for more incense, and for mounting higher in the scale of ambition, is constantly felt by its victims. The passions cannot be classified as merely pleasurable and painful ; for the passions ranked as pleasurable are seldom pure or unmingled with pain. Thus the happiest love is rarely clear from all pangs of jealousy, or the brightest hope from all sufferings of apprehension. And as though it were preordained that no human enjoyment should be complete, even when at the summit of our wishes, and under the full gratification of our most ardent passions, fears and forebodings of change wiU almost always sully the purity of our happiness. The same is also true of our painful passions. Most rare is it that we find them wholly immitigated by those which are pleasurable. Some faint beam of hope will pene- trate even the deepest moral gloom. It is questionable, then, whether any of the passions, could they be perfectly analysed, would be absolutely free from any mixture of their opposite. A large proportion of the painful passions in society are the offspring of such as are pleasurable. We suffer because we have enjoyed. Our present state is darkened by contrasting it with the brighter past. The reverse also holds true : as we suffer because we have enjoyed, so do we enjoy because we have suffered. Knowledge, too, or the enlargement of our ideas, in opening to us new fields of desire, and causing new comparisons wth our present condition, becomes a frequent sourse of discontent and the various painful passions of which it is the parent. Thus does our happiness too frequentiy depend much less on what we are, than on what we have been. We have seen that some philosophers based human conduct on the pleasure of sympathy, but moral conduct which is founded only on the pleasure of gratified sympathy stands on a somewhat insecure basis. Much of the sympathy which impels us to moral action is most unpleasant. ETHOLOGY : THE SCIENCE OF CHARACTER 5 A man sees a woman cast herself from a bridge into a cold and turbulent stream ; while he runs round to plunge in from the bank he may have time to think of the chill he is sure to get, of his ruined clothes, of the considerable chance his wife has of becoming a widow and his children of becoming orphans. He feels no pleasure in the prospect, nothing but anger that the woman should have been so wilful, and yet it is impossible for him to stand callously by and see her drown. If he tried to do so, something would boU in his blood, and as the time for useful action grew near an end, in spite of himself he would take the plunge and face all the inconveniences. Possibly enough, after he has got the woman out, he may feel no particular glow of pleasure, but only the chill of streaming underclothes. Thus sympathy is an emotion which, though in the main it gives pleasure, is by no means essentially pleasurable ; and we act upon sympathy not to please ourselves, but in obedience to certain primitive instincts — very often without thinking — which have been bequeathed to us by our ancestors, because without these instincts our ancestors would have failed to survive and we should never have existed. We have propensities, i.e., organic impulses, to malie us follow certain paths of life ; but we are not following them because these propensities serve a definite and ordained end in nature, but because the satisfaction of the impulse is accompanied by a pleasurable feeling. The animal is aware of the sensation of hunger and experiences appropriate pleasure from the food its taste approves of ; but it has no knowledge that the assimilation of new material is an indispensable necessity in the maintenance of animal hfe. Like the animals, so do we do innumerable things to which we are led by purely organic impulse ; things which indeed have a reason and a use, but a reason which we never know, and a use which we never discern, till we come to think. Such thinking, which we apparently do in obedience to a higher voice, is pecuharly human, and never wanting even in the most degraded of human beings. This impulse, disposition, and ability to reason, is as intuitive and congenital in man as the disposition to eat. None of our faculties seek pleasure for its own sake, although pleasure results from their attaining their ends. A woman loves and tends her children, and it makes her happy to do so ; but she does not love and tend them that she may feel happy. And so of all our desires and motives to action ; they none of them have happiness directly for their object, but if pleasure did not follow from the pursuit, or unhappiness and pain from the neglect, they would cease to be motives. The greater the strength and activity of a mental quality, the greater the pleasure attending its exercise. To a person with a highly developed aesthetic sense to behold a beautiful picture will be pleasurable ; to an unmusical person, music may create a painful feeling. Happiness signifies a gratified state of our faculties. The gratification is achieved by exercise. To be agreeable, that exercise or pursuit must be proportionate to the energy of the aptitude or disposition ; if it be in- sufficient, discontent arises, and its excess produces weariness. To achieve complete felicity is to have all the mental powers exercised in the ratio of their respective develop- ment. A man is tender, hard, credulous, cynical or benevolent as a result of the pre- dominance of one or more innate quaUties which turn the scale in that direction, and, whatever his disposition, he desires gratification from following it ; he acts in certain ways because it suits him to do so. In one order of mind there is happiness in relieving the suffering or misery of others ; in another order of mind there is happiness in adding pound to pound. Everyone acts according to his own dis- position, but those deeds are most praiseworthy which are for the good of the largest number. The propensities are simply rudimentary impulses whose expression is wholly determined by the social environment. Mental Ufe is rooted in the propensities. It 6 ANALYSIS OF MAN'S PSYCHICAL NATURE is not true, as JAMES has said, that man has more " instincts " than animals ; but it is true that he has more propensities than any single species of animal. In all the higher animals there is a highly developed nervous system, with multitudes of connections between its elements. These connections are pathways of nervous currents. Many of these connections are inborn and seem to be as much a part of the heredity of the individual and the race as physical characteristics. The nervous system is thus characterised by a multitude of more or less perfectly developed pre-organised reactions which are a part of the individual's heredity. Propensities are then inborn pathways of nervous currents, which have as their functional correlate inborn motor tendencies, and as their psychical correlate inborn psycho-physical dispositions. They are evidently the psychological aspect of racial heredity, and it is as inconceivable that the organic individual should exist without them as without the equipment or general bodily structure itself. As propensities are not acquired by the individual, but are given in the germ, they are transmitted from generation to generation, varying only as other biological charac- teristics of the stock also vary. Inasmuch as they are characteristics of the highest and the most unstable portion of the organism, the nervous system, they probably vary more widely than the grosser physical traits. They are more modifiable and alterable, owing to the fact that only about one-third of the connections of the nervous system are made at birth, the other two-thirds being acquired by the individual during his lifetime. These acquired connections must, of course, very greatly modify the character of the original connections. There are in man, there- fore, no definite, hard and fast instincts such as characterise the lower types of animals, but rather a complex series of propensities to action. Repeated resistance to impulses builds up a habit of self-control ; repeated yielding a habit of self- indulgence. The crimes and folhes of mankind are mainly due to the uncontrolled operation of the propensities (the " flesh " of theology). EVOLUTION OF THE MENTAL POWERS The first step to be taken towards the formation of a science of character is to analyse human behaviour and endeavour to ascertain what are the primary mental powers. Without such classification one cannot proceed in any methodical way to describe individual character. But it must be understood at the outset that these mental powers are potential only ; that they are only presumably primarj^ but on further investigation may be found rather complex ; that we still lack suitable terms for many of the fundamental capacities, instincts, and propensities ; and that, though we shall describe them singly, they do not act singly, but that in- tellectual, emotional and volitional activities are inextricably intermingled. The method we shall follow is what we have already described as the " natural history " method. As we have seen, the defect of the earher attempts at a classification of the impulses which are the mainsprings of behaviour has been that their authors treated man too much as though he stood alone in the animal creation, as if his propensities and capacities could be studied without reference to the connections which may be established between them and Uke endowments of the lower animals. But there are a number of elementary powers which we possess in common with animals, which are aroused spontaneously, and are implanted by nature for the preservation of the individual and the race. Man and animals being in a world, the inhabitants of which devour one another, the most important safeguard with which they are endowed is the propensity of self- preservation. This consists of several dispositions. First of all there is the love Of life, giving a disposition to guard themselves against mechanical injury and destruction. In order to maintain existence, the animal must have a propensity to seek food. Since many animals and man five on other animals a propensity for ETHOLOGY : THE SCIENCE OF CHARACTER 7 aggression is necessary, and in order that they themselves may not be devoured they must possess a disposition for self-defence ; these tendencies giving rise to the emotion of irascibility, which increases the natural strength of the animal. But not all animals are endowed with weapons for self-defence ; nature has provided them, therefore, Avith a disposition to take flight and a disposition to conceal themselves and their intentions in case of danger ; and, in order not to be taken unawares, nature has endowed them with the emotion of fear and the feeling of suspicion. Food not being always available, some animals developed a propensity to hoard nutrient materials, and some developed for their protection a propensity to construct a habita- tion for themselves and their offspring. The continuance of the species was assured by the provision of a sexual pro- pensity, and when young were born there developed an attachment between parents and offspring. The young growing up together formed an attachment to one another, giving rise to a feeling of affection, and frequently they became attached to the place in which they grew up, and thus developed a love of home. Family life taught them that there was greater security in numbers, and thus developed the gregarious propensity and the foundation of social life. For the individual to live in a group a certain conduct favourable to the preservation of the herd was necessary, and those who conformed would meet with the approval of their fellow-members. Thus arose the love Of praise and dread of blame. Some members of a group, being more gifted than the rest, would take the lead and thus acquire self-reliance and tenacity of purpose. The self-preservative propensities brought man into collision with his fellowmen until he was schooled into respect for each other's interests. From this moment was estabUshed the principle of altruism, which is at the root of all moral progress. For the acquisition of food and the maintenance of self and the species powers of observation are necessary. These impart retentiveness and supply the essential material for practical knowledge. By the comparison of past experiences with the present, and tracing causes and effects, the reasoning powers arose. Man, being endowed with speech in addition to the language by gesture which animals possess, could think in the abstract as well as develop powers of imagination, with which he. could endow certain objects with greater excellence than others ; thus developed the aesthetic sense. Imagination renders persons susceptible also to impressions of happiness and distress in others ; and where there are no strong antagonising motives in the mental organisation, feelings of justice, kindness, charity, and generosity, i.e., ethical and altruistic sentiments, may arise. Moreover, the grandeur of natural phenomena impressed him and aroused in him feelings of awe and wonder and reverence. Believing these phenomena to be caused by supreme powers, and in time by an Almighty Power, the religious feeling was aroused. These are, briefly sketched, the primary mental powers, with which we shall deal in detail in succeeding chapters. EMOTIONS AND PROPENSITIES versus INTELLECT Psychologists have concerned themselves greatly with the reason of man, as though the human mind comprised within its domain nothing further than mere intellect, but we all have propensities which give rise to desires, and we all feel and strive as well as think. Indeed, the feeUngs and propensities are the prime-movers of the intellect and of the greatest biological significance. (Even WILLIAM JAMES, who furnished us with a new theory of Emotions, devoted nine-tenths of his ' ' Treatise on Psychology " to the consideration of the Intellect, and only one-tenth to FeeUng and Will.) Our judgment is oftentimes influenced by our desires and feelings ; in too many instances, indeed, the intellect is made the servant of the feehngs and propensities. Rouse the emotions and men cease to reason, for the emotions focus 8 ANALYSIS OF MAN'S PSYCHICAL NATURE the ideas and actions of a man into one channel, cutting off all other thoughts, impulses and incipient actions. Men are animals first and reasonable beings afterwards. Notwithstanding all that has been said of the " nobility " of the intellect, men's lives are not determined by it, but by their propensities and emotions. We experience satisfaction, dis- content, anger, fear, jealousy, hatred, or grief spontaneously, and these conditions influence our mode of thinking. These feelings are part of our organisation because there are objects and events which from their nature must be detested or loved, desired or feared, for the preservation of the individual or the species. According to BERGSON, the intellect has been formed to serve the purpose of activity which we call life. " Knowledge is for life, and not life for knowledge." If Bergson means by life the manifestation of the natural propensities, he is quite right ; for the intellect serves for their gratification, and not the propensities for the service of the intellect. Man may exist without reflection, but scarcely without action. The emotions and propensities supply the dynamic energy to human conduct. Without them there would be no stimulus to the exercise of the intellect ; for the intellect can appreciate facts but cannot supply motives. In judging a man, we have to ask what are the motives that habitually determine his conduct, whatever be the means his intellect may devise for the attainment of his ends. But all propensities have a good purpose ; only when wrongly directed do they become vicious. On their activity depends all the good and evil in life. The cat may see the mouse, but that has no effect upon her if no emotions are thereby aroused. The mouse may see the cat, but its subsequent activity is due to the emotions thus induced. Why should a man pick up a lump of gold at his feet, even though his intellect should inform him first that it is truly gold and that certain things might be procured in exchange, unless he has some desires, some hopes, which gold may satisfy, or some fears which gold can alleviate ? Even the study of science is maintained only by emotion. It may be the emotion of ambition, or some other stimulus, as a feeling of curiosity. It is plain at least that without emotional stimulus we obtain no sort of return for our labour, and only through our emotions can we find any motive for it. Fame and wealth are the two most power- ful incentives to human enterprise. One man may have a magnificent intellect, but no emotional stimulus to exert it ; another may have poor talents, but, with the capacity for taking pains, may know how to turn his abilities to good account. The influence of certain politicians and sections of the Press is so great because of the appeal they make artfully and successfully to the people's emotions. Indeed, many of the " intellectuals " are moved by it against their previous convictions, and those who hold fast are in a minority and muzzled for the safety of the herd. The affective tendencies — that is, the feeUngs, emotions and passions, differently named according to the degree of their intensity— preponderate over the intellect and determine the nature and hfe of the individual. Man only thinks as he feels. The feehngs promote thought, unless they become too strong, when they inhibit j intellectual activity. Were we deprived of our feelings, the remainder of our consciousness would amount to nothing ; our sensations would lose their pleasure and pain ; our thoughts would be bereft of all interest and vitality ; our convictions and ideals would lack the quickening touch of the spirit, and fall as empty sounds on deaf ears. Education, law, pubUc opinion, tend to repress impulses and to produce uniform conduct ; but nature will out. One man is still more afiectionate, less ambitious, more amorous than others ; and that these pecuharities are innate, and not the result of education or training, is evident from the contrasts which we observe between members of the same family. ETHOLOGY: THE SCIENCE OF CHARACTER 9 If the propensities for self-preservation were untutored, every man would have impulses for killing, thieving, lying, etc. — though we do not always call them by these names. Their existence is shown in certain states of clouded consciousness and in brain disease, when these propensities manifest themselves in their full vigour and in the coarsest manner. Because of this untutored manifestation, these propensities have been called evil or immoral ; but they are simply non-moral. For only out of action can morality be evolved, and only by desire can primitive man be spurred into action. The feelings are not only far more extensive in their action than, the intellect, but are more important for health and sanity. In mental derangement, the primary disorder usually consists in a tendency to disordered emotion, which affects the course of thought, and consequently of action, without disordering the reasoning processes in any other way than by supplying them with wrong materials. | The greater the intellect of a man, the greater the check upon his emotions and passions. The lower the power of the intellect, the more freely do the feelings I influence the actions of the individual. Hence a child, a savage, and persons of no culture are little able to restrain their inclinations. Hence also in injuries to the intellectual region of the brain, the loss of control over the propensities. But reason seems to have that power only by exciting a higher feeling to suppress the f lower, so that the struggle is, as a rule, between feeUngs, and not between reason ' and feeling. The feeling is first aroused, and the intellect steps in afterwards. • Consequentl}' the ready response of the primary emotion when a man is offended — ^to fight someone — the first animal propensity. An irascible combative person knocks a man down, and thinks and reasons about it afterwards ; there is a blow and a word, not a word and a blow. And so, of all the feelings, we often act upon the mere impulse ; self -consciousness, or reflection, comes afterwards. In any given individual the intellect may be highly developed, and the passions and emotions very ill developed, or the reverse. The fool may have a kind and affectionate heart, and the criminal a quick wit. Of course, intellectual and moral defects may also co-exist. Were intellect not entirely distinct from emotion (a view not shared by the great majority of psycholo- " gists), the complete idiot would be also incapable of manifesting any emotion ; whereas, on the contrary, his emotions are manifested the more strongly for lack of the inhibitory control of reason. The propensities are the basis of the higher powers ; and whilst the emotions and propensities can exist without intellect, intellect cannot exist without them. Indeed, without the promptings of the propensities, men would die. We do not live for the purpose of gratifying our propensities, but we exercise our propensities in order to live. In some persons the animal, the baser nature, would appear constitutionally to predominate, the passions readily breaking from the control of reason, and bringing too often sorrow, shame and disease upon the unhappy individual. In others the reverse of this is true ; the intellectual nature holding the supremacy, ever keeping the feehngs under a just restraint ; and fortunate indeed are they "whose blood and judgment are so well commingled." As the good tendencies greatly preponderate in some natures, so do the bad in others ; and we meet those who scarce ever from their childhood manifest an amiable or generous feeling. Such extreme cases, however, are fortunately but rare. Generally there exists in our composition a due mixture of the good and evil dispositions : " Our virtues would be proud if our faults whipped them not ; and our crimes would despair if they were not cherished by our virtues." Virtue depends on the successful struggle with our evil dispositions. Chastity would be no virtue in one without carnal desires, nor clemency in him who was incapable of lo ANALYSIS OF MAN'S PSYCHICAL NATURE hatred or anger. The poets glorify their gods by making them war with demons. As the artist heightens and sets off the bright and beautiful colours of his canvas by the dark shades with which he intermingles and contrasts them, and exaggerates the beauty of his angels through the ugliness of his devils, so does Nature on her moral canvas enhance the lustre and comeliness of virtue by the very shadows and deformities which she throws into the picture. Finally, there are those who from very early existence are distinguished by the predominance of some particular passion as fear, anger, or ambition ; that is, they are constitutionally timorous, irascible, or aspiring in their tempers. Education, however, may do much in repressing passions originally in excess, and developing such as are deficient ; and herein consists moral culture, so vitally essential to our health and happiness. The emotions predominate over the intellect by their stability and relative duration. Perception, thought, contraction of the voluntary muscles are in- stantaneous functions. They are scarcely begun before they are ended. The emotions and their muscular and organic effects are slow and more lasting. Only by their abuse can they be more quickly aroused. To become angry takes an appreciable length of time — minutes, or even hours, according to the organisation of the individual and the exciting cause ; and when the passion is fully aroused it continues for some time and passes off. Some of the emotions occur at such an early period that there is no possibility of their expression being in any wa)'' due to imitation. They are forms of instinctive reaction to the objects that excite them. Some children from their earliest years are more timid or more courageous, more secretive or emulative than others ; some are naturally inclined to jealousy and others to affection. Violence of temper is often associated with exceedingly good health. We must note that one may be of a timid disposition and yet be not inclined to anger or jealousy, and be affectionate and be still lacking in courage. We must also note that the infant feels anger, fear, attachment, before it is alive to the sublime or beautiful ; and it observes occurrences long before it reasons. The intellectual capacities and the emotions are two distinct sets of mental powers ; but, in their manifestation, are commonly blended together. A feeling of some kind arises at or about the same time as the idea and is associated with it. On the other hand, just as the intellect may work independently, so the emotions may manifest themselves primarily without any ideas. For example, there is often anxious feeling without any idea. The individual experiencing that feeling may seek for a cause and may fasten upon some idea ; but the feeling comes first. A man may be in a state of irritability amounting to anger, before he has been opposed or had occasion to find fault. It relieves him when he can discharge his anger on some individual or object, though he or it may be innocent of any offence. In the various disorders of the bodily organs, glandular secretions, arterial changes, there are often remarkable emotional states, for which the patient may account in a legitimate way by events in his mental life, not suspecting their physical origin, until the bodily disorder is so marked that he feels compelled to consult a physician. THE NATURE OF INSTINCT Much confusion has been caused by the actions of animals being referred to instinct ; whereas the thoughts and actions of men have been referred to intellect. One bird as soon as it is hatched runs into the water, and it is said it does so by instinct. Another sings by instinct. Others migrate by instinct. Some animals make provision for the winter by instinct. Now, though we cannot call in question the propriety of such a term, can we suppose that the one entity — instinct — will explain all these various phenomena ? On the other hand, all the actions of men ETHOLOGY : THE SCIENCE OF CHARACTER ii have been referred to intellect ; but though intellect is necessary for the successful prosecution of human affairs, yet does it explain how one man may possess a taste for music and exhibit no talent for mathematics or poetry ; or how a man may be a natural orator and excel neither in poetry nor mathematics ? This diversity of talent, I am aware, has been attributed to the peculiarities in the mental constitu- tion, and the opinion is so far just ; but it is not sufficiently explicit. We shall account for it in succeeding chapters. Man is born with certain innate capacities, and he is born with desires to exercise these capacities. The same is the case in animals. These capacities are at birth mere potential tendencies, and even an instinct is only a tendency. For example, nest-building is an instinct in the bird ; but which particular tree, and which branch of the tree, shall bear the nest, these are not predetermined. There is no internal compulsion in the bird to select one tree rather than another. There is freedom of choice in that respect. That is to say, while the act of nest-building is determined, in its main features, by internal organisation, and is in this respect instinctive, it is Subject in its details to the operation of choice in adaptation to circumstances, and is, in this respect, reasoned. Moreover, the animal can take up its instinctive work at any time, at any stage, and pass from one business to another. Instincts may appear mechanically performed, but they are not ; for instincts may be altered. All living organisms have the power of improving their position by adapting themselves to external conditions. Such adaptations imply intelligence. There is no instinctive behaviour without an intelligent factor ; and there is no intelligent behaviour without an instinctive factor. Instinct in man is a term generally used in describing that part of human character and conduct which is not the outcome of a consciously rational process ; but there is no " pure " instinct in man, such as exists, for example, in insects. It is always associated with ideas in the adult human being. For this reason I propose to reserve the word " instinct " for such innate capacities as are followed by be- haviour more or less automatic, and to which the whole species reacts in exactly the same manner ; and I call " propensity " an innate impulse to action, which is neither automatic nor uniform, but is controlled largely by the animals' intelhgence. Adopting this view, animals have both instincts and propensities ; but man has only propensities. They impel him to certain actions, but there is no innate guidance how that action is to be performed. The elements of knowledge and skill are lacking, and the impulse to act is not necessarily followed by its execution. (" Sucking " in the human infant is regarded as instinctive, but resembles rather reflex action.) A person may have, for example, the propensity to hoard very marked, and manifest it in a desire and conduct " to get rich." The acquisitive propensity being so strong in him, he will seek ways and means to gratify it. Therein he has choice in accordance with his innate abilities and the circumstances in which he is placed. He can exercise his reason to discover how to gratify the tendency, the active exercise of which gives him pleasure. Instincts, in the lower animals, dictate the end, and not only the end, but to a considerable extent the means by which the end is achieved, and leave but a margin, larger or smaller, to the guidance of reason. Propensities, whether in man or animals, give rise to desires for a particular end, but leave it almost entirely to reason to discover the means of attaining that end. If man were provided with instincts, and not merely propensities, he would not require such a long period of protection and instruction. What we call moral education is really largely the proper direction of the propensities. Take the nutritive instinct, i.e., the instinct of the animal to obtain food for its 12 ANALYSIS OF MAN'S PSYCHICAL NATURE sustenance. The chick, immediately on leaving its shell, has not only the impulse to seek food, but knows how to obtain it ; and all chicks act alike in their manner of procuring food without previous teaching. The human being, on the other hand, has merely a propensity to acquire food. He requires to be taught how to obtain it (even in " sucking "). Such desire for nutrition arises out of, or is excited by, physical conditions of the stomach, or system at large, which demands the supply of food and drink,and thus serves as monitor to solicit the co-operating acts necessary to furnish such supply. Consequently, animals, as soon as born, and independent, of course, of education or imitation, go through, and as perfectly as ever afterwards, all those complicated muscular movements requisite to meet the demands of nutrition. The human being, however, hungry and with food placed in front of him, if untrained and left to himself, would starve. Instinctive action resembles reflex action, but is not carried out with the same fatal promptitude immediately upon the stimulus ; being more complex — consisting of acts, rather than mere movements, and being accompanied by feelings. Con- sequently it includes a sort of consciousness, though not consciousness of the actual end of the action. In the reflex movement, on the contrary, every form of con- sciousness has entirely disappeared. The more instincts an animal has, the more it leads a life of hesitation and choice — an intellectual Ufe. Apparently, because it has no instincts ; really, because it has so many that they conflict with each other. Thus man is more uncertain in his reactions than the lower creatures, because he possesses all the primary propensities that they have, and a great many more besides ; but they become greatly modified ; firstly, owing to the greatly prolonged period of immaturity and consequent parental protection ; secondly, owing to the possibilities of profiting by tradition — ^the store of acquired knowledge — being immensely increased ; and thirdly, owing to the great development of his intellect and moral sense. ■ What constitutes the superiority of man over animals ? Does he excel them by the possession of more exquisitely constructed senses ? No ! In this respect he is inferior. The eagle has a keener eye and the dog an olfactory apparatus of much finer susceptibility. Do we find man's superiority in the instincts ? No ! The instincts of animals are more powerful than ours, for the wants by which they are expressed manifest themselves more clearly, and are satisfied by actions of much greater energy. Nor is the difierence between human and animal types due to the monopoly of mind by man, but solely in a greater development of the intellect and moral sentiments. The fundamental character dispositions are common to both man and animals. Affection, love, hate, discontent, satisfaction, envy, jealousy, revenge, magnanimity, courage, fear, anger, joy, love of approbation and pride, are not human attributes alone — all of the higher animals possess them. Only the perception of the subUme and the religious emotion are absent in animals, because they depend upon ideas of too abstract a nature to be reached by the mind when unaided by the logic of signs, that is, without language. All the other capacities animals seem to possess too, but most of them are very slightly developed. It is impossible to deny that animals possess intellectual capacities to a certain degree. Some possess even better powers of observation than man ; and they possess understanding, though not in the same degree as man. They evidently retain the images of bodies, and are perfectly able to recognise objects which they have once seen. We cannot be convinced of this by any oral testimony on their part, but it is proved by induction. Tliough a dog cannot speak and communicate his feelings, it is evident that he recognises his master, or any other individual with whose person he is familiar : that he becomes attached to his benefactor, and avoids those who treat him ill ; that he has perfect remembrance of the shed which covers him, etc. A thousand facts prove ETHOLOGY: THE SCIENCE OF CHARACTER 13 that he thinks of these objects when far removed from them, regrets their absence, and views with pleasure preparations for a journey which he imagines will bring him nearer to his home. The dog, therefore, hke ourselves, possesses sensation, perception, comparison and memory, and in many cases he seems only to want language to become an intelligent being. We might even accord him a sentiment of personahty, but this he is unable to express. Animals are quite as able to form abstract ideas as we are, if under abstract ideas we include general ideas of qualities which are so far simple as not to require to be fixed in our thoughts by names. Animal intelligence is unable to elaborate that class of abstract ideas the formation of which depends on the faculty of speech. It is wholly impossible to over-estimate the value of language as thus the handmaid of thought. For, in the absence of language, it would be impossible for thought to rise above the very simplest of abstract ideas, while, in the presence of language, it becomes possible for us consciously to predicate qualities, and so at last to feel that we are conscious of our own consciousness. Were not the various qualities of the understanding manifested by animals identical with those possessed by man, there could be no intercommunication between man and animals ; for without this mutual intelhgence the rider could not manage his horse, nor the sportsman direct his spaniel, nor the pig-boy drive his pigs, nor the blind man be led and guided by his dog. Animals and man must understand each other, otherwise animated nature would be a confusion. Even sounds of the voice and the meaning of words are frequently understood by animals as distinctly and fully as they are by ourselves ; and the intent and object of our actions are perceived by them in the same sense as we intend them to be perceived. Thus the horse knows the sound of the trumpet, the sound of the whip, and the driver's bidding ; the hound responds to the huntsman's horn ; the cat minds the maid -servant's call, and the cow obeys the cry that hails her home to be milked. The mechanism of the beaver is like our own, and the fox pilfers our poultry-yards with the same adroitness as the thief pilfers our coffers. Thus the intelligence of animals is the comparative anatomy of the understanding of man ; what is one in us is several in them. They are the analysis of the mind of which we are the standard and type. By pursuing this train of reasoning we might show that the less perfect understandings in man approximate to the lower understandings of animals. Thus we say as stupid as an ass, as filthy as a pig, as timid as a lamb, as cruel as a tiger. The higher human understandings admit of no such debasing comparison, since they cannot be likened to anything else than themselves. The primitive propensities which prompt man do not manifest themselves in the same rude and open manner as they do in animals. Nor are animals hindered in the manifestation of their innate qualities by restraints. On the other hand, man receives a long process of education, and is surrounded by restraining forces, such as famUy ties, pubUc opinion, communal interests, besides the activity of his understanding, which all help to control the impulses which urge him in certain directions. Man, like the animal, has to kill that he may eat, has to oppose aggression and to shun danger ; he has pleasure in eating, drinking, sleeping, and exercising his limbs ; and one of the greatest obstacles to improvement is that so manj'^ of the race are contented with this enjoyment, and consider it painful to seek higher sources of gratification. Man has added to his animal nature moral sentiments and reflecting .faculties. But this peculiarity attends them : that while the animal propensities act powerfully of themselves, his rational faculties require to be cultivated, exercised, and instructed before they will yield their harvest of enjoyment. Therefore, the necessity of moral education of his young : to develop the higher human sentiments in the child and to leave the lower instincts inactive, or, at least, to put them under control. Evil thoughts and deeds were at one time ascribed to the instigation of \ 14 ANALYSIS OF AfAN'S PSYCHICAL NATURE the devil — no doubt their manifestation is due to some form of temptation ; but it is we alone who are responsible for making wrong use of the powers which are given to us. Of course, it is not always wickedness, but sometimes also ignorance, that leads to their unwarranted manifestation. Man has an insatiable appetite for knowledge, for the discovery of new truths, which is the stimulus ever urging him forward in the path of intellectual endowment. The relations of an animal to the objects among which it is placed have reference chiefly, if not solely, to the gratification of its appetites, or the satisfaction of its bodily wants, and its preservation from injury or destruction. Its sensual desires gratified and unthreatened by danger, it commonly falls asleep, or at least remains at rest. But such is not the case with man, certainly not with civihsed man. With his appetites satisfied, with ample provision for every physical necessity, and exempt from even the remotest apprehension of harm, still, actuated by a class of wants above those of his mere animal nature, does he remain awake — observing the objects and phenomena about him, reflecting, perchance, on his own mysterious constitution and its intricate relations, observing what passes within himself ; or, unsatisfied with the present, stretching his view far into the dim, uncertain future, and judging, or trying to judge, of its fast-coming events. Nor is his expanding mind bounded by the world in which he dwells ; he grasps at the universe and eternity, and space and time are too limited to contain it. Man has the advantage above animals of being able to profit more largely by experience, the results of which he can communicate to others, in like manner as he can avail himself of their experience ; and this is communicated by one generation to another — each adding, as it were, fresh layers to the sum of human knowledge. The instincts of animals lead to no progress. The beaver constructs his habitation, the sparrow his nest, the bee its comb, as did their ancestors thousands of years ago ; while man, owing to the records of past experience, has been gradually advancing to a higher and more perfect state of development — each generation profiting by the learning and experience of those that preceded it, and in like manner transmitting its knowledge and attainments to those that come after. Very young children present in their mental constitution, in common with animals, chiefly those mental powers which we call propensities. With advancing age, the first indication of true intelligence seems to consist in the power of forming special associations. Memory thus appears early in life, and long before a child is able to speak it links together in thought ideas of objects which it finds to be associated in fact. Again, the emotions begin to assert their presence at a very- early period, and attain a high degree of development before any of the charac- teristically human faculties can be said to have appeared. Moreover, in young children we meet with nearly all the emotions occurring in animals, and their general character is much of the same kind. In more advanced childhood, the emotions of children resemble more those of savages. With regard to the more purely intellectual faculties, language is largely intelligible to a child long before it is able to articulate ; but soon after it is able to articulate the power of abstracting quahties and classifying objects by the aid of signs begins its course of development. But, in comparing the intelligence of a young child with that of an adult animal, we are met with this difficulty — that as the bodily powers of children at so immature an age are so insufficiently developed, the mind is not able, as in the case of animals, to accumulate experiences of fife. In order, therefore, to obtain a fair parallel, we should require a human being whose mental powers have been arrested in their development at an early age, so serving to supply the aborted human intelligence with fuU experiences of life. Now, the nearest approach we have to these conditions ETHOLOGY: THE SCIENCE OF CHARACTER 15 is to be found in the case of idiots. There are, of course, all degrees of idiocy. As we descend in the scale from the higher to the lower grades, so we find the charac- teristically human faculties are the first to disappear, while those faculties which man shares with the lower animals persist. Or, reversely, as we ascend in the scale, so we find first the animal faculties only, and higher in the scale, some of the more characteristically human. THE WILL AND THE POWER OF CHOICE We have eyes to see, legs to walk, and a nervous organisation with which to think and feel. The legs are instruments to give us the freedom to walk where our desires direct us ; the eyes are instruments to give us the freedom to look at what appeals to us, and the brain-cells serve as instruments for certain elementary capacities and dispositions, which give us the freedom of the loftiest thoughts and most supreme feelings. We cannot walk without legs, nor see without eyes, nor think or feel without a brain. Any defect in these instruments restricts our liberty. We must grant the existence of the instruments, but no one can tell what use the individual will make of them. We can make a teleological teddy-bear that will walk across a thoroughfare, but not a teddy-bear that will choose the route and will avoid the traffic. The man who thinks grand thoughts, feels beauty, aspires and loves, is the citizen of an ideal world ; no theory of philosophy can make an automaton of him. Fatalism is wrong. There is no predestination, though there is a plan in the universe. There is a desired goal, but not a destined goal. For example, every healthy child is planned to live to eighty or a hundred years ; but that is not its destiny. Usually three meanings are distinguished, in which freedom is attributed to the Will or " Inner Self " of a human being : (1) The general power of choosing among different alternatives of action ap- paremtly without a motive, or against the resultant force of conflicting motives ; (2) The power of choice between the promptings of reason and those of appetites (or other non-rational impulses) when the latter conflict with reason ; (3) Merely the quahty of acting rationally in spite of conflicting impulses, how- ever strong. It is obvious that freedom in this third sense is something quite distinct from freedom in the first or second sense ; and, indeed, is rather an ideal state after which the moral agent ought to aspire than a property which the human will can be said to possess. It very frequently happens that a desire passes at once into action, so that we are not conscious of an interval between the two, as in the satisfaction of the propensities. But it also frequently happens that there is a conflict of desires, causing us to reflect and compare the consequences which would result from the gratification of the several desires. It also occasionally happens that, even when only a single desire is operating, something occurs to suspend its passing into action. In both these cases we are conscious of an interval between the desires, or the conflict of desires, and the action which is the result. The interval may be so brief that we can hardly detect it, or of a considerable duration. To tliis act of determination we give the name of volition. The Will, by those who regard it as an independent part of our nature, is supposed to be the source of these volitions, or, in more precise language, a power or aptitude enabling us to form them and to retain them until the moment of action arrives. Volition is determined by two factors : the external circumstances by wliich a man is at any moment surrounded, and the various desires and thoughts excited by them in the man himself. The former are external to the man altogether. i6 ANALYSIS OF MAN'S PSYCHICAL NATURE whilst the latter are determined by his actual character at the moment ; and his actual character, through an unbroken series of experiences and developments, has been determined by the potential character which was his when his life began. In our full consciousness we act as we choose, but our choice is usually determined by our character, i.e., by those dispositions which we inherited and followed habitually. We can control our innate desires and innate dispositions, but we cannot eradicate them. The man with the character of a lamb, or the character of a fox, the French- man with his French inclinations, and the Englishman with his English inclinations, are described as such because of their habitual conduct ; though, as we have repeatedly explained, they can change to a considerable extent by making a conscious effort to do so ; only under certain circumstances will the original dispositions reveal themselves. Unconsciously we act according to the strongest motive ; but consciously we can choose — not the motives, but among the motives. And although the strongest motive will have the greatest attraction for us, we can act contrary to it. We are f not compelled to do anything. From this it follows that, the more conscious and the greater the knowledge of self (our dispositions) and the world, the freer we are. « The mere fact of a person having a character means that tendencies are so uniformly the same that he can be trusted under similar conditions to act always in the same way. Our character is our limitation, and if we had no limitation we should be unrehable. We have all our natural dispositions, and cannot change in one day. If we do, our friends will watch us with anxiety. Of course, the man of reason and in full con- sciousness can, if he chooses, go contrary to his natural dispositions ; he can do so ; though, as a rule, he is a creature of habit and indulges his strongest impulses, i.e., he follows the path of least resistance. For this reason, freedom so often leads to vice, instead of being a blessing. Our friends may be able to tell us what we would do under certain circumstances, but they cannot tell us what we must do under certain circumstances. External factors also mould the will. Man, considered as a moral agent, is dependent on the civilisation which surrounds him, on the force exerted upon him by the accumulated actions of the generations which have gone before him. The land he lives in, the nation into which he is born, its laws, its habits, its religion, fix certain limits to his action which he cannot pass any more than he can jump off his own shade. He is born a member of a special society and grows up with the beliefs, customs, and traditions with which that society endows him. He finds himself under the dominion of a moral code, of a moral standard of duty, of inrooted prejudices and practices, accepted by current opinion, to which he must give assent if he wants to remain a member. Within these limits he may act well or ill on the impulse of noble ideals or enslaving passions. He is a free agent within the hmits which these surroundings determine ; he is not a slave to them, for he has the power of modifying them. Man is subject also to the influences exerted upon him in his infancy and child- hood. Education and experience tend to modify the inherited dispositions ; but none of us have been free to choose our parents, or our ancestors, or our early sur- roundings. Therefore, by the time we are free to determine our actions for our- selves, our habits and our character are to a large extent already formed. Now, any act which we consciously wiU to perform and do not perform automatically, or under pressure of physical coercion, we perform and will to perform because our nature is such that we look on the results of such an act as desirable. Every creature hkes its own ways and takes to following them as a natural thing to do. Thus neither animals nor man are conscious of any restraint. For example, the man, generous by nature, gives freely at the sight of suffering ; whereas the miser, even if he can realise the sufferings of others, gratifies his tendency of saving and adding pound to pound. Both act in accordance with their own ETHOLOGY : THE SCIENCE OF CHARACTER 17 organisation. Both follow the line along which their most active powers urge them, which is the line of least resistance. If the passion of love is strong in us, we think we have decided to love ; whereas our organisation has rendered us more hable to be stimulated by such external impressions as would arouse love. Emotions of fear, anger, pity — in fact, all the primary emotions — may be so strong as to render any balancing of the ends in view out of the question. The man agitated by jealousy and the desire for revenge considers himself free so long as he feels satisfaction from the achievement of his desires. When the storm calms down he changes his tone, and acknowledges that he was carried away by the impulse of the passion. The drunken man and the mad man, the angry man and the man in love, all think themselves free ; yet when they recover they cannot always account for their actions. Daily experience teaches us that some men are inclined to be virtuous, while others are inclined to be vicious. We do not change anything by saying that such tendencies are the result of their innate dispositions. Daily experience teaches us that one man wills to devote himself to art — sees, talks, and loves in art — while another wills to make money — sees, talks, and loves for business only. One man is unhappy if he cannot court women to the exclusion of all proper occupations ; another sits over his books and loves learning for its own sake. These are acknowledged facts, and in stating them we are not altering nature, we are not taking away the liberty of the person ; we are only explaining his disposition. Every one of these men may act differently if he chooses ; but he does not choose, unless he is endowed with other strong dispositions as well, because he derives no pleasure from following other pursuits. An act of willing is always determined by some motive. The will itself has no decision ; but the motives decide the will. This does not mean, however, that the motives fight it out among themselves. We select among them, choosing to identify ourselves with one and not with another. The choice made depends upon the person choosing as well as upon the motives prompting. Of course, we do not select our own motives ; they are partially determined in our characters. When there is only a single and immediate motive, we term it an impulse. The greater the variety of motives, the more hesitancy in action. WTien there are two or more desires present, we usually choose to identify our- selves with the strongest. Thus the benevolent man may be very strongly moved to part with some money to a person who has the appearance of being in distress. Perhaps he himself at some period of his life went through some such experience. This would still further increase the impulse to relieve the sufEering of his fellow- being. However, the memory of his own past sufferings may awaken simultaneously the fear of his again falling into trouble through the parting with his hard-earned money ; he may also recollect that at the time he did not always receive the ready help which he now wants to extend to the suffering stranger, and that only through his saving instinct he became what he is now. After such deliberation, the saving instinct stimulated by the emotion of fear, predominates, and the silver coin is returned to the man's pocket. The more numerous the impelling motives, the freer the individual. It is the man with the greatest choice of motives, the man whose mind is cultivated and in whom the social and ethical sentiments — sympathy, benevolence, love of justice, etc. — predominate over all selfish desires, who enjoys the greatest freedom, and whose conduct can be least determined. The less a man is educated and the lower his ■ organisation, the fewer motives will he have, and the more easily can his actions be predicted. In most men the propensities, i.e., the natural appetites and crav- ings, predominate over the reason. When the senses are excited, the individual feels an incUnation to yield to impulse, but so long as his reason continues normal he weighs consequences, and thus may will precisely the reverse of what his desires Vol. ii.] c r8 ANALYSIS OF MAN'S PSYCHICAL NATURE would have led liim to effect. Many men, however, lack that power of inhibition : they readUy consent to their desires. The thoughts are often merely the expression of the propensities. For example, thoughts of love in a youth on the approach of an attractive maiden, thoughts of profit in the greedy business man on a favourable opportunity of sale or purchase, thoughts of infidelity in a jealous person on the slightest suspicious circumstance, and so forth. We imagine tlaat we ordain the direction of these thoughts, whereas very often we are only following them. That is why so many men are mere automata and their actions can be predicted. The will which is swayed entirely by low motives is less free than that swayed by higher motives. Consequently, when a person is blamed for having done ill, he is not blamed for not having acted without motives, but for not having been actuated by the highest motives. Moral reprobation attaches, not to the bare act, but to the balance of motives to which the act is an index. When persons pray for power to resist inferior temptations, and to follow the inspirations of the spirit — that their will may be directed towards certain actions and turned away from others — they acknowledge thereby that the will is susceptible of being influenced, and not free to act without a cause. If there existed unrestricted hberty, there would be no need for the moral education of children in restraining over-active propensities and developing weaker sentiments. It is only persons of arrested mental growth, in whom the moral sentiments never are developed, who lack sufl&cient choice of motives. Without such freedom of choice there can be neither vice nor virtue. The will can be improved by education, because education improves the intellect, and intellect guides the will. SOCRATES said : " Man acts wickedly only from ignorance, even the villain who appears to act .with consciousness. To choose between money, power, knowledge, or virtue depends partly on the power of the propensities, partly on education ; both, however, depend on the intelligence." Socrates shows us that he knew the intellectual powers ought to be stronger than the propensi<-ies, because the will follows the strongest inclination ; and although we may beUeve, before deciding, that we are quite free to choose, yet when we have chosen we often repent. In the animal world, desire is usually followed without any other restraint than fear ; whQe in man it is largely, though no doubt very imperfectly, Umited by self- control. Most crimes spring not from anything wrong in the original and primal desire, but from the imperfection of this higher, distinct or superadded element in our nature. Immoderate and uncontrolled desires are the root of most human crimes. Punishment aims at repressing undesirable conduct by supplying deterrent motives against it, holding that conduct is determined by the influence of motives on character. If the will were beyond the control of motives, punishment would be absolutely purposeless or simply vindictive. The will, then, is not the determining agent, but is the result determined by the impulses and reason. The \vill can have no content other than that supphed bj' the involuntary flow of ideas and feelings, and can only have unrestricted freedom of choice between the objects thus put within its reach and desire. Thus viewed, both free will and determinism are true. We are free and we are controlled. As LAVATER said : " Man is as free as a bird in a cage ; he can Uve within certain hmits." What some philosophers and theologians mean by free will is will without a cause. That is impossible. The only freedom of which we are conscious is freedom from compulsion in choosing among things which are presented to our choice. For choice, there is always an efi&cient reason, or there would be an effect without a cause ; and our freedom is the power which we have to act in accordance with the choice. ETHOLOGY : THE SCIENCE OF CHARACTER 19 Ordinary unphilosophical persons may profess some vague belief that the will is absolutely free ; but for all practical purposes they believe that conduct springs from character, and habitually act upon that behef . Our dealings with individuals are regulated by our estimate of their characters. Business would be impossible if conduct were at the mercy of an incalculable wiU. We address ourselves to each individual differently according to his known disposition. When we wish the covetous man to act we speak to him of his personal interest ; we appeal to the benevolent man on grounds of pity and the pleasure it must give him to do good ; we supply the vain and ambitious man with a motive to action by promising him great praise for the performance which we recommend to him. Indeed, the best reader of human character, in this way, is often the most successful man. There are men who are strong-willed in some directions and wealc-willed in others — weak-willed in their business or professional capacity, and tyrants in their domestic affairs ; and there are strong-willed rulers in pubUc life who have no will-power in their family circle. Will is not only a power to act bat also a power to restrain. Freedom is the power of inhibition of instinctive and non-rational acts. Man can fashion his outer and inner conscious purpose, according to the ideal set up for his guidance ; he can discipline and inhibit his propensities and natural impulses, so that they shall no longer move him. It is to be understood, however, that the determining principle itself must be native to man ; this he cannot give himself by his will, for it is the innermost will itself. Now, there are men who lack this innermost will-power — it is frequently lost in nervous exhaustion — and who in consequence become easily addicted to grooves of thought (obsessions), morbid habits, undue emotionality, etc. In these we have to re-educate the character, to supply fresh ideals according to their individuality ; we have to teach them how to suppress undesirable thoughts and feelings, or how to direct them in other channels. This is the so-called " suggestion " treatment, which will be dealt with fully in a later chapter. The older psychologists spoke of the will as if it were a separate entity, presiding over the mental powers and originating courses of action to the exclusion of all motives. If will were an entity, it is notably infantile in the child, imbecile in the idiot, grows in power, range and quaUty as the mental powei^s grow by education, is mature in the adult, falls sick with the body's sickness, and becomes decrepit in old ■} age. It is not the will that directs ; it is the thought that directs. Will is the i. concentration of the thoughts towards the desired end, the focusing of the thought- J ' forces. We are conscious of free will, but not of absolute free will, for we are conscious also of our limitations. No man can will to be a poet, an artist, an athlete, a Socrates or Archimedes if he does not possess the necessary capacities. Men speak Of absolute free will when they cannot even command their own ideas. We are all haunted at times by certain ideas or memories of past experience. Had we a per- fectly free will we should not allow ourselves to be troubled by our imagination day and night. We may by change of topic, association, fresh impressions, get rid of some troublesome idea ; but to dismiss it at once by an effort of will is often beyond our power. How can there be an absolute free wiU, when the will is limited by other wills ? Man, as has been already pointed out, exists as a member of a community and has to adapt his will to it. We talk about liberty, but we are really slaves to our environment. Most men are satisfied in being no more than one of a herd, without independent personahty. The persons who defend loudest the illusion of an absolute f ree-wiU are often those who never strike out a line for themselves, but simply follow convention. It would seem sometimes as if not only good breeding but the highest morahty consisted in following the rules of respectable society, and therefore it is that in every place the 20 ANALYSIS OF MAN'S PSYCHICAL NATURE best, most lamented, and virtuous man is he who has strictly obeyed the laws of his country and regarded the land of his birth as the best in the world. Thus it is that persons who have never had an idea beyond what their immediate sur- roundings have brought forth are said to have led a blameless life, and have had every virtue inscribed in gold on their pretentious tombstones. On the other hand, the exceptional men of genius, those of Literary and scientific aims, who have had more brain than was ready to act in a simple reflex manner, but have not con- formed to all the customs of society, have been mourned over as reprobates. This fact is often overlooked by moralists and preachers. Habit it is which compels us to the performance of a large number of our daily acts ; conventionality is what we worship in society ; we give it our highest praise, and call those virtuous who walk in its paths, so that even a commonplace man who could not get out of the routine of the manners of his little town has a monument raised to his honour. Convention rules social life. Every one of the many professions has a peculiar character of its own, which, with rare exception, it inflicts on those who follow it. There is the shopkeeper type, the manufacturer type, the lawyer type, the medical type, the clerical type, the soldier and the sailor type. And we distinguish with ease, on the slightest intercourse, to what class a grown person belongs. It is to be seen in his look, in his tone of thought, his voice, gesture, even in his handwriting, and in everything he does. Another class of limitations to freedom includes those which spring from our own conduct. Action creates habit, and habit influences future action. Character grows with every exercise of the mental powers, and, if it does not altogether control, it certainly affects conduct. Thus we seem to be continually setting self- created limits to our own liberty. That there is no absolute free will is also shown by the effect which circumscribed Injuries and disease of the brain have on the manifestation of character. We shall show by numerous examples in later chapters of this work that the brain^ when thus abnormally affected, may change the moral quaUties formerly possessed, may make the religious man profane, the honest man a thief, and the chaste a profligate — and may abolish the will-power altogether. CHAPTER XXVI EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES We shall now proceed to analyse the psychical capacities of man in detail, describe their individual action, and the eflEects of their combined action on human conduct (as well as their morbid activity as observed in the insane) . This is a rather novel attempt and may be very imperfect ; but there can be no doubt of the value of laying the foundation for such a study, not merely to the student of philosophy, but to every man whatever his vocation in hfe. We are generally acquainted with the leading characteristics of our friends and acquaintances, or at least have no difficulty in ascertaining them ; but few people trouble to draw the necessary deductions as to the elementary motives of human behaviour. Knowing the primary dispositions and the degrees of their development in a particular individual we should be enabled to predict his conduct, a knowledge which, especially in the case of youths, must be of paramount importance for the gauging of their capacities for a particular career, for their moral education, and to ensure their future happiness. LOVE OF LIFE The most primary and universal desire of all organisms is the desire to live — ^the love of life — and to guard it. Nature has protected it not only by the pain which is always inflicted whenever it is endangered, but has endowed all beings with an instinct of self- protection ; i.e., an instinct to guard the body against mechanical damage or destruction, giving a tendency to avoid obstacles and dangerous objects, and an instinctive wish to preserve it even in the midst of acutest suffering. But for this instinct we should never move out of the way of danger, never raise a hand to avert a blow, never resent an injury, never provide ourselves with the means of subsistence. If the self-preservative instinct were absent, and we were guided entirely by the preponderance of pleasure and pain, suicide would inevitably be resorted to whenever pain predominated over pleasure. If the individual had to wait till experience taught him the necessity of self-subsistence and of self- protection, experience would arrive too late to be of any use. In insanity, especially in melancholia, the " love of life " is often lacking and its loss leads to attempts at suicide. Deeply demented persons, no more than young children, can safely be trusted to be alone ; they are unable to exercise the simplest care and forethought. Idiots, too, rarely attain to the degree of intelligence that enables them to guard themselves against even obvious dangers. THE ALIMENTARY PROPENSITY Another primordial propensity for the preservation of the individual is the alimentary propensity, making the animal search for food in order to maintain life. It is this appetite for food which directs maa, even when new-bom, to remove the 22 ANALYSIS OF MAN'S PSYCHICAL NATURE pain of hunger and thirst, the only pain then removable by an act of his own. In man, when the nutrient materials are defective in the blood, or it is imperfectly oxygenated, the man becomes irritable or quarrelsome, showing the intimate con- nection between the aggressive propensity and the desire for food. In satisfying hunger and thirst there is a great sensory enjoyment, quite apart from the relief it gives ; indeed, if the impulse to eat was not made known to us by the cravings of hunger we should be unaware of it, and should believe that we ate simply because we were attracted by the taste of food. For man's tastes are not limited, like those of brutes, to foods and drinks which provide nourishment. By usage, or adoption, he has added to his dietary a vast number of substances the sole use of which is to give pleasure. The abuse of this instinct leads to gluttony and drunkenness. Often a brilhant appetite is associated with an atrocious digestion. The insatiable craving of hunger, even when the stomach is full, is a common lunatic symptom. Some, having devoured their own ample allowance, seize all they can lay hands on, prowling about the entire day in search of food. We also find sometimes morbid desires, longings, or impulses for various substances generally regarded with loathing and disgust. Similarly the desire to drink may become a mania. Sometimes the insane refuse to take nourishment from a great variety of motives, according to the form of insanity. A patient may be immersed in his thoughts so that the sensation of hunger is deadened ; he may refuse it because he fears it is poisoned ; another, because a voice told him that he must not touch it ; another, because he is too great a sinner to receive God's gift. In aU we have the same symptom of suppression, or perversion of the instinct, associated with very difierent motives. THE COMBATIVE PROPENSITY AND THE EMOTION OF ANGER Another universal propensity is the combative propensity, which is really a com- prex tendency, being required for aggression as well as for self-defence ; and may be said to involve aggressiveness as well £ls resentment. Since most animals hve on other animals, i.e., on moving things, every creature must be able to stop, fight, destroy, and kill in order to obtain food ; that is the necessary condition of their existence, which can only be satisfied by an adequate expression of aggressiveness. And since every animal is thus liable to be killed and devoured by others, it must be aUve to, and able to remove, the dangers by which it is surrounded, and must be capable of inflicting injury on its foes in self-defence, i.e., it must possess a propensity to resent. This fundamental propensity is abso- lutely needful for the preservation of the individual. Of course, not all animals have weapons for self-defence — many of the herbivorous type, animals who Uve on stationary things, have not ; and not being equipped for the fight, they " fear " the enemy and fly from him. Fear is another instinct, with which we shall deal presently. The aggressive instinct probably arose through the sensation of hunger, which necessitated killing for food. Never is a beast so savage as when hungry, and in a measure this is true of man. Gradually, animals also killed for the mere sake of killing. In the latter case, it is not the capture but the pursuit which is the joy ; just as in our love of hunting, which is a relic of ancestral hfe. Man not only must defend himself, but must resist all kinds of aggression. He must defend not only himself, but his family and property. He must possess the power to repel aggression ; hence the instinct of resentment. In order to defend himself he must be also in a position to assail ; he must have the power of aggressive action. He cannot always wait till he is attacked ; sometimes it will be more prudent for him to go boldly at the enemy. Savage man surrounded by ferocious EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 23 animals could not wait till attacked ; he found that it was best to set out and destroy these beasts. All Uving nature is in deadly conflict. Eat, or be eaten, is the law. Every- where it is one bloody fight for existence. Man has so much modified his animal instincts that it comes to him as a shock to be told that he has a propensity to fight and kill. We must go to primitive man, when nature was still " red in tooth and claw " and the law of hfe was to kill or be killed. If man now fights with machine guns and tanks, instead of his nails and teeth, those enemies that would deprive him of his means of existence, it is the same primitive instinct which still actuates his mind. Human nature has not changed. The animal fights from im- pulse without any thought of the pain it inflicts. Man is often mindful of the pain he can cause ; he is artfully cruel, and " brutal " is not the word for it. The mere spectacle of a battlefield with the appalling mass of hideous suffering deliberately and ingeniously inflicted by man upon man should be sufficient to shatter all idyllic pictures of human nature. Man lives in a beautiful world and has a mind capable of solving the profoundest mysteries of nature and assuming god-like virtues ; but the foxes and wolves of humanity manage somehow to mislead the good men and to use them for cutting each other's throats. " Peace on earth " is much spoken of, but the true spirit is shoAvn not by what is said, but by what is done. To-day every civilised country trains its citizens in the art of kilUng — and in nearly all countries an apprenticeship to this art is compulsory. History is in the main a monotonously hideous record of successive wars and slaughters and the glorification of those who have success- fully made war. The recent world-war has cost millions of lives to give some nations supremacy over others and to drive them, at least commercially, out of existence. It is the colossal concentration of wealth anxious for its safety, or seeking further expansion, that moves governments into conditions which bring about war, and leads to terms of peace that lay the foundation for future wars. At the outbreak of war the enemy is depicted as so vile that men believe they are fighting and sacrificing their lives for the realisation of high ideals. But, when peace is declared, are the conditions better for themselves and for the coming generation ? Has mankind become better spiritually, or richer in hate, in revengefulness, in in- toleration ? A testimony of the brute nature of man may be found in HUXLE\''S "Ag- nosticism " : " I know of no study," says he, " which is so unutterably saddening as that of the evolution of humanity, as it is set forth in the annals of history. Out of the darkness of pre-historic ages, man emerges with the marks of his lowly origin upon him. He is a brute, only more intelligent than other brutes. . . . He attains a certain degree of comfort, and develops a more or less workable theory' of life in such favourable situations as the plains of Mesopotamia or of Egypt, and then for thousands and thousands of years struggles with varying fortxmes, attended by infinite wickedness, bloodshed, and miserj^, to maintain himself at this point against the greed and the ambition of his fellowmen. He makes a point of killing and otherwise prosecuting all those who first try to get him to move on, and, when he has moved a step further, foolishly confers post-mortem deification on his victims. He exactly repeats the process with all who want to move a step farther." In individual civilised human beings this propensity manifests itself in a refined manner. Whereas primitive man resembled the animal in having to enter into combat and destroy to obtain the food necessary for hfe, in our own day this pro- pensity is greatly modified and altered, because our great civil organisation has made money, by reason of its purchasing power, the chief protector of life. In course of time, civihsation has diminished the necessity of physical aggression and defence, and it has become no longer necessary for man to kill his personal enemies by way of punishment. He devised means of getting redress through the administration of 24 ANALYSIS OF MAN'S PSYCHICAL NATURE justice. Only nations envious of each other's possessions behave still like highway robbers and have not yet risen to that lofty standard. The codes of war, however, show the effort rational man makes to clothe with decency the shame of his own primitive instinct. The pubUc attitude towards malefactors has undergone, during the last few generations, a great alteration. Until a hundred 3'^ears ago they were treated by punishments of the most savage and even barbarous character. The gallows, the axe, the stake, the wheel, the quartering-block, the rack, the thumbscrew, and the boot were employed with horrible frequency ; and such retaliations of society on its depredators are now regarded with horror. Nowadays the malefactor is handed over to the courts of justice and is treated with consideration, if not with tenderness. By some he is regarded as the victim of heredity ; by others as the victim of cir- cumstances ; and yet others blame the victim — society — for the depredations of those that prey upon it. In our time this propensity is greatly modified and altered also, because of the growth of the understanding and of the social and moral tendencies amongst civilised races. Were there only propensities and intellect, many men would use their intellect for the gratification of their propensities, as animals do, but the evolution of the moral sense in human beings opposed such tendency. But if man is better able to govern his instincts or passions than are animals, it does not at aU follow that these passions or instincts are more feeble. They are simply more under the control of the understanding. The aggressive instinct and combative tendency is of use not only in the contests of the battlefield, but in the collisions of civil life, whenever our views happen to clash with, or to be opposed to, those of others ; and it may display itself in the bloodless contests of the Bar and council chamber. It enables us to resent and resist, to overcome difficulties, and to find pleasure in encountering opposition. There is no quality in which men differ more than in the combative instinct. While some individuals are so devoid of it as to shrink from the most trifling opposition, there are others who are never so happy as when engaged in a vigorous contest, such as to employ to the utmost their whole powers and means, both offensive and defensive. Education and habit cannot account for it, though they may modify its activity. The propensity of resentment is accompanied and aroused by a special emotion — that of irascibility or anger. This emotion is necessary in order to stimulate the physical energy and give the animal strength for the fight. The sight of its foes arouses an animal's energies to furious rage, whereby spontaneous muscular changes are developed all over the entire body and the strength of every muscle is exalted. This is a reflex mechanism of immense preservative value in the struggle for existence. Similarly, when a man is angry, the spontaneous impulse is to inflict injury on the originating cause of the emotion awakened. Sometimes he destroys innocent objects to give vent to his anger. Anger not only increases the physical energy but gives fire and force to some of the other powers of the mind. The energy of its impulse adds itself to and reinforces that of other impulses and so helps us to overcome our difficulties. The raising of the voice in anger is an automatic manifestation akin to the roaring of the lion and intended to strike terror in the opponent. A man devoid of the pugnacious instinct would not only be incapable of anger, but would lack the push and spirit and the reserve energy which is called into play in most of us by any difficulty in our path. Anger has its justification, therefore, in the roused energies of the organism reacting against an impression hostile to its self-preservation and self-expansion. Its discharge is natural and useful when wisely guided. The aggressive instinct can be active without anger. It gives to the character its executive energy and power, without which no undertaking can be successful. EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 25 The self-preservation of man and kindred animals is effected through mechanisms which transform latent energy into kinetic energy to accomplish adaptive ends. Probably it is the consciousness of strength which imparts boldness, courage, aggression ; just as a sense of weakness begets timidity. Indulgence in feelings of anger and vii dictiveness tend to make those subject thereto more and more habitually prone to outbreaks of these vices. Frequent anger, commonly called temper, is unfavourable to sound judgment and i nbiassed opinion. Anger may be rational, but its highest pitch — rage — is brief madness ; for the main characteristic of madness is loss of self-control, and this is exactly what happens to people in a passion. The instinctive fury, the violent and destructive mania of some madmen, is no different, is only the same mental power acting in excess. Different individuals, owing to their native temperament, bodily health, and moral education, vary remarkably in their propensity to anger, as also in the pertinacity with which they cherish this passion. In some it is sudden and transient, while in others, though perhaps less hasty, it assumes a more deep and lasting character, settling into that malignant feeling called revenge. Anger is sudden and impulsive resentment, in which the hostile reaction against the cause of pain is unrestrained by dehberation ; while revenge is deliberate and controlled resent- ment, retrospective, inflicting punishment for past injury. It was most marked in the savage, who had to avenge all wrongs offered to himself, his relations, his tribe. Revenge was a duty and a right. Hate often precedes and succeeds anger. The object of anger is particularly apt to be the object of hate. What anger accomplishes by a volcanic outburst, hate accomplishes in a slower, but surer and subtler way. Envy is hate combined with a certain very compound concept. It is aroused by the superiority of some individual to ourselves, which we regard as a sort of a hindrance or injury, against which consequently we feel resentment. If we make attempts to bring down its object to a lower level, to compass the ill of its victim, this is malice. Jealousy, too, is a very complex compound of love, fear, suspicion, and often hate. Like hate, it depresses vitaUty and keeps the body in a peculiar explosive condition, so that violent paroxysms of anger suddenly burst forth at a touch. Jealousy is a species of envy, but the latter invariably is attached to real or supposed Superiority, while jealousy attaches to equality, or even lower, and has therefore a wider signification. Those in whom the instinct of resentment is very active generally manifest also great force of character, executiveness, tenacity of purpose, and energy of mind, which enables them to overcome whatever obstacles oppose their progress. If they have large self-esteem as well, they may show sternness and severity of character, great indignation when displeased, and give their commands in an impressive and fear-inspiring manner. Such a resentful disposition in a person of nervous tempera- ment leads to peevishness, fretfulness, and irritabiUty. The combative instinct in a person of small intellect leads to easy provocation, ready quarrelling, and the kindling of strife. When combined with a dominant acquiring instinct, the person may " quarrel for a penny." Combativeness with httle caution leads to foolhardi- ness, and when combined with large intellect and the gift of language, such a person will be fond of debate, and will prefer to argue on the opposite side of the question. People in whom the combative instinct is defective disUke quarrelling and will avoid it, surrendering much for the sake of peace ; they have no Uking for severity of any kind, and would use physical force only as a matter of necessity ; they threaten more than they execute, and show anger to httle effect. If they are persons with large sympathy, they secure their wishes more by persuasion than by threats, and cannot bear to see suffering. If they are very cautious and of a 26 ANALYSIS OF MAN'S PSYCHICAL NATURE nervous temperament, they are likely to be timid, irresolute, and may see lions ■where there are none and make mountains out of molehills. In this manner the effects of combinations of the combative instinct with other dispositions might be described, but these examples will suffice to demonstrate the importance of ascertaining the primary dispositions of a person, and to show that one can predict from their combination the " likely " conduct under given circum- stances. The systematic study of ethology would thus prove eminently practical and beneficial to humanity, a goal that pure psychology could never reach. Irritability of temper from slight causes, a tendency to take offence easily, noisy arguing, unpremeditated violence and, to a lesser extent, designed violence, are common symptoms in several forms of insanity. Often there is violent anger against everybody and everything. Or its subject ^vill exhibit a general moroseness of character, or a malignant hatred toward, and a disposition to inflict cruelty, and even death, upon, particular persons, especially such as are most near and dear to him when in a rational state of mind. Some insane patients are impulsively destructive to material objects only, such as glass or furniture, and are quite harm- less in other ways ; while others will make assaults on persons as well, with or without intent to kill. These are the really dangerous lunatics ; they form only a small minority, and even in them such outbursts of passion can be avoided by proper care and treatment. Slight irritability from exaggerated sensibihty may occur in neurasthenia. One of the characteristics of hysteria is instability of temper. Mere argumentativeness, rarely anger, is one of the symptoms of dementia prcecox. In the early stage of mania patients become irritated on the slightest provocation, but their irascibility does not last. The general paralytic, too, may be easily roused to anger, and is also more or less easily calmed, at least at the onset of his disease. Noisy, abusive, violent temper is seen in acute alcoholism ; unreasonable irritability, unprovoked anger rising to bUnd impulsive passion is seen in chronic alcoholism. Peevish dis- position, bad temper, impulsiveness giving rise to dangerous acts, occur in epileptic insanity. The highest degree of irascibility is seen in acute mania, where we get excessive anger, violent language and conduct, sometimes lasting for daj's without any interval. Explosions of violence occur when least expected, and may lead to attacks on any person who happens to be present. In certain delirious states and melancholia agitata the patient raves and destroys, but his activity is conditioned by painful states of feeling and frightful hallucinations, and is analogous to the acts of a sane person enduring torture. PROPENSITY TO TAKE FLIGHT AND THE EMOTION OF FEAR Defenceless animals and animals recognising the superiority of the enemy instinctively take to flight. The struggle for existence of the different species of animals has exposed them, especially the weak, to continual risk. The conscious- ness of past dangers has caused them to fear the enemy and, when possible, to run away from him. The emotion of fear has its object in nature to make the animal shrink from danger. This must often happen automatically, otherwise it proves useless. There is often no time for reflection. Were there no emotion of fear experienced, there would be no apprehension of danger. Fear is perhaps more essential to the human species than to the brute creatures, for we do not possess the same facihty of avoiding danger by rapid flight, or of concealing ourselves by what may be called instinctive strategems. Certain things arouse fear in young animals before they have learned by ex- perience what things are signs of danger — as loud noises, rapid approach, strange or large things. Generally speaking, the unfamiliar arouses the fear instinct, for what is unfamiliar may be a menace to hfe. This is especially important in weak and defenceless animals, such as hares and rabbits, whose only refuge and safety is EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 27 in running. Animals which must receive actual injury before experiencing pain are clearly inferior to those which experience emotion-pain before the injury is actually received. The effect of fear upon the system proves its uncontrollable influence. The sudden stopping of the heart-beat and respiration, and the paralysis of movement in which it sometimes finds expression, are due to the impulse to concealment ; the hurried respiration and pulse, and the frantic bodily efforts, by which it is more commonly expressed, are due to the impulse of flight. P. CHALMERS MITCHELL, Secretary to the Zoological Society of London, in his work on " The Childhood of Animals" says that he tried animals with snakes ; and all the animals on which a snake would feed showed no signs of fear. There was no trace of any transmission from ancestors of inborn fear or recognition of such a universal natural enemy as the snake. But this is no proof that fear is not innate. A child will approach a fire and walk across a street without compunction. Fear is innate, but not fear of fire, or fear of street traffic. A child may play with a lion ; that does not say that fear may not be very active in it. BENJAMIN KIDD (" The Science of Power," London, 1918) similarly holds that fear arises entirely as the result of social heredity imposed on the young of each generation by training and example and nearly always under conditions of a strong emotion. Yes ! but the element is there in different degree. Some animals of the same species and brood are more afraid than others. A solitary cow having her first calf may attack a passing stranger, surely not from social heredity. Kidd says when once the emotion of fear has been set into activity the animal could not be tamed. That shows the apparatus is there, only not manifested until aroused by experience. So human emotions may remain more or less latent, just like the primary intellectual capacities remain latent until stimulated by training. If Kidd were right, the taming of animals would be an easy task. We need only take the young as soon as they leave the nest or their mother's breast, and since they will be free from fear, we can breed from them when they grow up, and thus create a species — say of rabbits or of hares — free from fear. Fear sounds the trumpet- note of danger. With little fear, there is frequently Uttle caution, and the danger is not seen until escape is impossible. The objects of fear vary according to the individual constitution. Each man has his special fears, as his fear is combined with other sentiments ; thus there is fear of loss of money, power, reputation, and many other things besides life. The tendency to fear and to employ the intellect to take precaution has been very unequally developed in the different individuals of our species. We find a more profuse manifestation of the feeling of fear in natures more intensely and variously sensitive than the average. Those who feel strongly the ill consequences of a false step are moved to avoid it ; they may be afraid or they may not ; fear is not necessary to active precaution. Normally it produces prudence and circumspection ; when deficient it causes recklessness and carelessness ; in excess it causes indecision, cowardice, and, in some, such a depression of spirits, that with the slightest misfortune they fail into despair and think life no longer worth living. Fear incites us to avoid, or flee from, dangers. When escape, however, is impracticable, the emotion may change and the individual will often be driven to the most fierce and desperate resistance ; thus even the greatest cowards have sometimes acquired the fame of heroes. We cannot feel fear and anger at the same time ; but anger may follow fear. Courage frequently means bhndness to danger, a lack of imagination to realise the horrors of a distant catastrophe. A man who is mentally alert and well- informed, and therefore able to gauge pretty accurately dangers he is called upon to face, is not hkely to distinguish himself for physical courage. On the other hand, the naturally timid, if they possess the higher faculties, may be stimulated by duty. 28 ANALYSIS OF MAN'S PSYCHICAL NATURE honour, pride, so that in many instances they become bold and successful warriors. The most delicate and effeminate in body, through the ascendant influence of their moral nature, have faced dangers and borne sufferings under which naturally stouter hearts and firmer nerves quailed. Fear will oftentimes spring rather from mistaken judgment than from any absolute deficiency of courage. Familiarity with any particular danger, according to a law of the animal constitution, serves to diminish our dread of it, although it may not necessarily embolden us in respect to others of a different character. Fear is not only an essential instinctive feeling for the protection of the in- dividual, but it is also a powerful agent in the preservation of social order. For there is no doubt that the apprehension of punishment materially influences man's conduct. A child -with little moral sense but large fear may, from dread of punishment, avoid telling falsehoods, until with years the habit of speaking the truth has become a second nature. Fear is also the basis of morality among many uncultured people. They do not steal because they fear the gaol, and they do not murder because they are afraid of the gallows. It is already a moral advance when a man has large domestic affections and will not steal, not because he fears gaol, but because it would give pain to his mother, wife, or sisters. We all behave ourselves, in a measure, for " fear " of public opinion. Circumspection and foresight depend on the emotion of fear, but are essentially intellectual manifestations, compound and not fundamental therefore. Circum- spection is calm, sustained, intelhgent efiort to accomplish a purpose. Foresight is an intelhgent perception of the probable effects of present circumstances, and a conception of coming causes and their resultant consequences. Circumspection is one of the most comprehensive powers of the mind, and its co-operation is needful in all states and conditions of life. Instead of being a simple, unresolvable power, it is very complex, and springs from several intellectual faculties and emotions, of which the emotion of fear is but one. Every circumspect act is the result of the judgment, or the judgment is the approximate cause, though fear may be the remote or inciting cause, which is the only part it can play in circumspection, and it is not in all cases the principal cause. Circumspect animals keep a sharp look-out for danger, and therein we have the origin of foresight. The cautious and prudent are those whose fears are far-sighted. Instinctive prudence is very different from simple reflective prudence. Dread is fear of a future event. Fear, in its most aggravated degree, acquires the name of terror. That particular condition which it has been imagined certain animals have the power to produce in certain others, termed fascination, is not unusually ascribed to the agency of terror, which paralysing, as is thought, all voluntary muscular action in the victim, renders him an easy prey to his destroyer. Terror is paralysing ; the individual is " rooted to the spot," and has the appearance of death, an effect which in some animals is protective. Horror is a painful detestation, more or less mingled with fear, of particular objects, which usually neither threaten nor, in fact, cause the slightest apprehension of bodily injury. Grief is a complex emotional state, consisting of love and fear, with an idea. A mother sees her child dying, and her grief is intense ; but if we could destroy her love for the child her grief would cease at once, though she might feel sympathy. Grief, then, in this case, is love combined with the fear of death. Grief, like fear and all depressing emotions, causes a rise of blood-pressure. A profuse shedding of tears relieves the blood-pressure and frequently also the mental state ; that a good fit of crying eases the grief is a common observation. EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 29 Despair is the name by which we express the most aggravated degree of mental depression. Under this dreadful feeling, no nay of hope, no sunbeam of joy, breaks in upon the gloom. Fear normally stimulates eflEort, in normal despair there is absolute inertness. One may fear or be frightened a little, but there is no littleness in despair. Desperation is the feeling of the inevitable. It is not misfortune that drives people to suicide, but a constitutional disposition to look at the dark side of things and to be apprehensive, often without cause or with insufl&cient cause ; for there are millions of people who bear with cheerfulness disappointment, loss of wealth, loss of husband, wife, children, friends, of health, character, or social position ; they do not dream of suicide. Fear is accompanied by a more or less sudden closing down of the blood-vessels of the body. We soon recover from the efiect when the cause is gone. But in grief a steady constriction is placed on the vessels, and the vital tone, though less sharply, is more permanently lowered. Dislike, jealousy, and hate are in their physiology closely analogous to fear and grief. The bodily powers which they restrain are still present, though kept in repression, and therefore liable to explosive manifestation. A man cannot be angry without having the object of his anger — whether real or imaginary — in his mind and wishing to oppose or destroy it ; he cannot be afraid without thinking of the object of his fear and wishing to escape it. But in joy and anxiety he experiences only a passive consciousness of his vascular condition. As regards the combination of other faculties with the emotion of fear, we may note that the disposition to fear in an intellectual person gives rise to forethought, carefulness, and prudence. When combined with an active combative instinct such persons may be slow in commencing, yet, once interested, they push on with spirit, and will combine discretion with valour, prudence with determination. The fear instinct in a person of nervous temperament makes them easily anxious and discouraged. The fear instinct with little combativeness, self-esteem, and hope, renders persons timid, destitute of energy ; they rarely venture and are likely to worry over misfortunes. Persons with little fear may lack care and prudence, and if combative they may drive forward in a furious, reckless manner. When fear is combined with the acquiring instinct a person may take care of property, but is likely to be imprudent in other respects. And if his acquiring instinct is small, he may keep money loosely. As regards fear and insanity, morbid fears of a special kind are common in neurasthenia and hysteria. Fear as to health and apprehension of disease is the main condition of hypochondriasis. Terrifying hallucinations occur in alcoholic insanity. Unreasonable excessive apprehension and vague feelings of anxiety are common in melancholies ; their whole life is tinctured with sadness, anxiety casts a gloom over all their thoughts and actions. They can find no pleasure in anything, and feel as if their body were fixed to the place where they are ; or else they may be so agitated as to run about in violent despair. Their delusions, if any, are not the cause of their disorder, but are mere efforts on their part to explain their misery. On the other hand, fear and anxiety, caution and prudence, are often diminished or lost in insanity and lead to actions resulting in the ruin of the patient and his family. PROPENSITY TO CONCEALMENT AND FEELING OF SUSPICION Animals had to protect themselves against their numerous enemies to avoid destruction, and developed a tendency to concealment, which was also found useful in approaching their own prey, and a feeling of suspicion. Suspicion is a protective propensity and hence a necessary quality. To hide is as instinctive as to run away. Hiding is protective because it falsely suggests to the adversary that there is nothing 30 ANALYSIS OF MAN'S PSYCHICAL NATURE for him to attack. It is, then, the beginning of deceit. An animal cannot alwajrs protect itself by open force, and it must make up in cunning what it lacks in strength and courage. Hence it conceals itself or its intentions. Thus wild animals make use of innumerable arts for procuring food and escaping from their enemies. The hunter studies the habits of the animals he pursues, that he may lay his snares and shape his proceedings accordingly ; so it is in human life. Those who are secretive and close in what regards themselves are vigilant in watching others with intent to discover, if they can, their sentiments and purposes. Cunning can outwit muscular strength and tends to develop the intellect in one particular direction. A person under the dominion of this propensity can conceal his own thoughts successfully and take a great interest in the concealed thoughts of others. This is the Sherlock Holmes type. Even small things, slight omissions, and the smallest peculiarities of man have their lessons for him, raise a suspicion, and are traced to their true source. To the guileless man such things generally go unnoticed. The mind of the secretive man has a familiarity with all underground channels of thought. He knows by instinct what the next move of the rogue is likely to be and can trip him up. Hence the saying, " Set a thief to catch a thief." The criminal who is deceitful prefers forgery and fraud to theft, and will use poison rather than direct assault to kill a person. Some men are by nature secretive, prone to dupUcity, hypocrisy, and cunning, while others are frank and open. A certain endowment of this power is essential. People who give utterance to every thought and feeling which arises in their minds, and confide their private affairs in a reckless fashion, appear to be both foolish and a nuisance. A man but moderately endowed with this power may nevertheless keep his own counsel, if he is possessed of caution and good judgment. Such a man may be frank and overflowing with his friends, but he will save himself with strangers by his caution. The man who has a fair share of this power trusts little without good cause, takes Uttle for granted, and consequently is seldom hoodwinked ; whereas the frank man is liable to think others equally frank and truthful and is easily deceived. A suspicious person, as, for instance, a jealous man, may reason quite correctly, but he will misinterpret actual occurrences in accordance with the state of his feeUng. Ill-founded suspicion is common in insanity. In such cases it is not the reasoning that is wrong, but the premisses that are ill-founded, actual occurrences being misinterpreted owing to the perverted emotional state. If the premisses are conceded, then is the conclusion perfectly correct. When the disorder has lasted some time, and the false ideas are habitually dwelt upon, they become realities to the consciousness of the individual. Such suspicious patients think that the people in the street look at them strangely ; they may fancy that the newspapers write about them, that pohcemen or supposed enemies are following them ; that there is a plot or conspiracy to rob, ruin, and destroy them. Suspicion renders people secretive ; they penetrate the thoughts of others and try to conceal their own. They are rarely indiscreet, and are generally able to restrain the outward manifestation of their feelings. Secret! veness with httle conscientiousness gives a cunning, deceitful disposition. A secretive, but social, person may sometimes communicate his feelings freely to his nearest friends, yet will seldom do so and will exercise more attachment than he expresses. Secretive- ness in a person very acquisitive and not conscientious leads to the practice of tricks of trade. With little suspicion, a person is generally frank, candid, cordial in disposition and intercourse with men, has few secrets of his own which he wishes to keep, and cares Uttle about learning the secrets of others. He may disclose his faults as freely EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 31 as his virtues. Combined with large caution, he may manifest great care and deliberation in laying plans, but be imprudent in the manner of execution. A person with large social feeling and little disposition to suspicion will enter readily iato conversation with strangers. Ill-founded suspicion of being despised or distrusted, or a marked person, is peculiar to paranoia ; innocent looks or remarks are interpreted as having some deep meaning and may lead to attacks on strangers. Melancholies sometimes have delusions of persecution, attributing their misery to the influence of others ; but they never react against their persecutors, but accept their supposed injuries as rightly deserved. Persecutory delusions, referring chiefly to mysterious objects and arising from hallucinations, are common to acute alcoholism. Chronic alcoholics are very distrustful, especially of the fidelity of the wife or husband. In senile dementia the delusions of suspicion and persecution are usually directed against the patient's own family, resulting sometimes in strange wills being made to the dis- advantage of the wife, son, or daughter. On the other hand, there is sometimes too much frankness in persons of dis- ordered mind. In the early stage of mania, patients unburden their innermost thoughts to chance acquaintances, and so do the general paralytics to undesirable companions. This association and intimacy with persons of inferior station in Ufe may be the first syTnptom which draws the attention of their friends to their mental state. THE PROPENSITY TO ACQUIRE AND HOARD The propensity to acquire and hoard is another primary propensity. Some animals found it useful not to have to hunt continuously for food, which may prove scarce at certain periods, and began to store up things for future use. Thus developed the hoarding propensity and love of possession, a tendency to lay up provisions for the future. Man not only stores up provisions for winter, but he acquires property of every sort and kind for all his life and for his posterity. The tendency to acquire varies in difierent people ; the ability to do so depends on the intellect and other requisite qualities. The hoarding instinct is one of the strongest and most general impulses of our nature, and, in fact, is the origin of wealth, by the tendency which it produces to acquire for the mere pleasure of possessing. For the sake of gratifjdng his desire to acquire, one saves where others spend ; one man is dUigent, and another speculates, to get rich quickly. In the child this propensity shows itself most naturally. The child will seize everything and appropriate what does not belong to it. Idiots and imbeciles will steal, the intellect being too deficient to check the animal instinct. Love of pos- session is a natural disposition implanted in the human organisation, and dishonesty is only the result of the absence of controlling motives. The hoarding propensity originated in the practice of accumulating, in times of plenty, a store of food that should serve for sustenance in time of scarcity ; and its obvious advantages soon caused the transfer of the desire and the practice to other things than food ; until, in the course of ages, it culminated in the practice of accumulating money, the symbol and potentiality of acquiring most things that are regarded as desirable. Having started as a means to the further end of security against future want, it has now, by the process of anticipation of future motive, become an end in itself ; and we have the familiar spectacle of men who have already accumulated money in excess of any possible need, still continuing the accumulation for the mere sake of accumulating. From food and money the practice has over- flowed, by an easy process of transference, to other things, some useful, many useless, and we now see people accumulating postage stamps and all kinds of queer things, merely to satisfy the instinct of accumulation. The love of wealth, as distinct from the desire for objects of immediate gratification. 32 ANALYSIS OF MAN'S PSYCHICAL NATURE in which it undoubtedly takes its rise, is an object of future gratification, and there- fore requires foresight. First we provide for our own wants, next for those connected with us, and ultimately wealth is amassed without any regard whatever for its future use. The amassing itself becomes a pleasure for its own sake. Its ill effects are a grasping and covetous disposition ; its good efiects, the stimulation of frugality and industry. When the desire for the accumulation of money has become a man's ruling principle, and he exhibits it on all occasions, he is called covetous or avaricious. For the crowd, the idea of happiness never extends beyond a limited circle of immediate and tangible satisfactions which can be bought with money. In order to succeed, all means are justified, and success is the sole measure of the value of actions. Success under its most brutal form, which is monetary success, has almost become the exclusive object of universal endeavour. The collective ideal is the same as the individual ideal — to get rich as soon as possible, and by every available means. As in private life, admiration and respect are accorded to those who have succeeded financially. The desire to become rich destroys the capacity for happi- ness when the riches are obtained ; but there continues a ceaseless activity. The governing classes are no longer the higher classes, and what remains of the old aristocracy has but little concern in maintaining its intellectual supremacy, or in constituting itself as a social force and setting an effective example. The only effective aristocracy that survives is that of money, and it cares for nothing save augmenting its wealth or spending it without intelhgence. The highest class to-day is a mere plutocracy. A man may be a thief without love of property, and he may be moral and yet grasping. There are many rogues who are not very acquisitive and who readily part with what they have stolen ; that is to say, they are dishonest but not selfish ; and there are many avaricious men who are sternly honest. In moderation, not out of proportion to the other impulses, we see persons not grasping, but with a con- servative and economical tendency towards property, and a disposition to take good care of everjrthing they possess. They waste nothing, but they are not necessarily selfish or very eager in the pursuit of wealth. Cupidity and greed are caused by general selfishness combined with this pro- pensity. Penuriousness is caused by this tendency being active in a timid or weak man. The pleasure of avarice consists in accumulating and hoarding up treasures ; in computing and gloating over them ; in a feeling of the power which they bestow ; and likewise in the consciousness of the possession of the means, though there be no disposition to employ them for the purpose of enjoyment. Envy is directed toward those who already, or at least as we conceive, enjoy something more and better, either internal and external gifts, than belongs to ourselves. When the acquiring propensity dominates, there is a disposition to turn every- thing to good account, which stimulates to the acquisition of wealth. When combined with cautiousness, such a person cannot endure to see waste ; he will sometimes deliberate so long as to miss good opportunities ; he will save rather than speculate. The acquisitive person with a hopeful disposition and small caution is likely to enter into speculative enterprises. The acquiring propensity combined with good observing faculties makes a man a good judge of the value of property ; and, in a man of large intellectual powers, makes him prefer a livelihood by in- tellectual pursuits rather than business, A person with only poor acquisitive propensity desires money more as a means than as an end. He may be industrious but lack economy, and is likely to show disinterestedness in pecuniary matters. The person with little acquisitiveness and aesthetic sensibility and desirous of approbation likes to buy beautiful things and to show them. The person with little acquisitiveness and a hopeful disposition may spend money in anticipation of future events and is apt to run into debt. A person EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 33 not acquisitive and very cautious may still acquire property ; but it is as a safeguard against future needs, and he cares little for it as property. Genuine kleptomania is probably due to an excess or perversion of this pro- pensity, where an individual, apparently sane in other respects, will steal anything he can lay hands on. It occurs in persons in whom there is a strong desire to take possession of things quite irrespective of their value, disregarding risks of detection and the consequences of exposure ; and it is accompanied by a feeling of restlessness and anxiety when the impulse arises and a pleasurable feeling of relief and satisfac- tion on the execution of it. As in the child, it is the appropriation which gives the satisfaction, and not the enjoyment of the article taken ; so that the objects appropriated are usually insignificant, considering the position and wealth of the patient. In consequence the stolen goods are not parted with for gain, are not valued or desired, but are quite thrown away, or accumulated uselessly, or they are forgotten. Kleptomania occurs in the mental disorder which sometimes accompanies pregnancy, in the clouded consciousness of hysteria, and sometimes in the semi- conscious state following an epileptic fit. Weak-minded persons are prone to commit petty acts of larceny, and head -in jury may also be a cause. In the early stage of mania the patient sometimes steals whatever he can lay hands on, but the articles stolen are often thrown away as soon as they are in his possession, and he steals almost openly. General paralytics, in the early stage of their disease, not infrequently steal without reflection, though sometimes with ingenuity, as a rule any article that takes their fancy. They also commit frauds of even,' kind, generally neglecting ordinary precautions. In the latter stages of the disease these patients again steal, but this time under the delusion that everything they see belongs to them. They then appropriate ail sorts of articles, hoard and conceal them, and immediately afterwards lose all recollection of them. In senile dementia, the hoarding propensity appears pure and simple, such patients filling their pockets or any available receptacle with anything they can lay their hands on, regardless of value, even with mere dirt. Among other perverted manifestations of the hoarding propensity in insanity we have, on the one hand, the patient who fears loss of property and destitution, or thinks he is already ruined ; on the other, the parsimonious man who suddenly launches out into endless extravagance, giving orders for motor-cars, jewellery, and' other luxuries, which he has often not the means to pay for, or else makes imprudent investments, or is given to impracticable business ventures. THE SEXUAL PROPENSITY We have dealt so far with the dispositions implanted by nature for the preserva- tion of the individual. We have now to deal with the propensities intended for the preservation of the speeies. The most primitive of these is the sexual propensity, or the tendency to propagation. To each individual, life is not a gift but a trust, to be employed in transmitting hfe to a new generation ; and, this purpose effected, the raison d'etre of the in- dividual is at an end. This is very clearly indicated in the lives of many of the lower animals, in which reproduction is followed at once by death. In man this propensity has reached great refinement, and given rise to the tender emotion of love, besides inspiring men to immortal productions in painting, sculpture, poetry, music, literature, and the drama. In insanity it is often exalted to an extraordinary degree, leading to the m.ost lascivious conduct — nymphomania in women and satyriasis in men. Indecent manifestations occur in general paralysis ; regard for decorum and the amenities of society is often lost in the mental disorder of the climacterium. Over-excitation is also common in the early stage of mania. The erotic tendencies are often revived Vol. ii.] D 34 ANALYSIS OF MAN'S PSYCHICAL NATURE in senile dementia, which makes the patients easy victims to designing women and often causes them to be so misguided as to fall in love with very young girls. PARENTAL LOVE The love of offspring — parental love — is an instinct inhetent aUke in animal and in human nature, and is one of the instincts necessary for the protection of the race. It is necessary that the young animal shall not, during the first period of its active Life, be dependent altogether upon its own efforts, for its highly generalised instincts would hardly suffice to maintain it alive unaided. Rather it must enjoy a period of sheltered fife, during which it may acquire, through experience, such specialisations of its innate mental structure as are necessary for independent existence. This period of protected immaturity Nature provides by developing in the species the parental instinct, which leads the adults of each generation to feed, protect, and shelter their young, while these add to their highly general innate knowledge a sufficient store of acquired knowledge. Among ourselves the credit of right conduct is freely and warmly allowed to the mother who works for her children, who denies herself many an innocent pleasure in order that she may feed and clothe and properly train her little family. But in almost all animals that attend to their young the self-same devotion may be found ; and it will be observed that, even in those who in aU other situations are very timid, any attempt to remove the young from the protecting parent, or in any way to hurt them, provokes a fierce and desperate display of all their combative re- sources. Take, for example, BREHM'S observation of the monkey-mother. " When the monkey suckling is unable to do anything for itself, the mother is all the more gentle and tender with it. She occupies herself with it unceasingly, sometimes licking it, sometimes running after it or embracing it, looking at it as though revelling in the sight of it ; then she lays it against her breast and rocks it to sleep. When the Uttle monkey grows bigger the mother grants a httle freedom, but she never loses sight of him ; she follows his every step and does not permit him to do everything he likes. She washes him in the brooks and smoothes his fur with loving care. At the least danger she rushes to him Avith a cry, warning him to take refuge in her arms. Any disobedience is punished with pinches or cuffs, but this seldom happens, for the monkey does not do what its mother objects to. The death of the young one is, in many cases, followed by that of the mother from grief. After a fight, monkeys generally leave their wounded on the field ; the mothers only defend their young against every enemy, however formidable. At first the mother tries to escape with the young ones, but, if she fails, she emits a loud cry of pain and remains still, in a threatening attitude, with wide-open eyes, gnashing her teeth and menacing the enemy with outstretched arms." Whether we call this instinct or affection, it is necessary for the maintenance of the species that things should be so. Still, desertion of infants and young children is not uncommon in human beings. In insanity the love for the child often turns to hate. LOVE OF HOME The reminiscences of infancy and early youth are the source of an attachment to the place and surroundings in which we live, giving rise to a love of home, which further extended gives a love of country — a patriotic attachment. Patriotism is one of the most lauded virtues, but it is often wilfuUy perverted by rulers by inculcating in the thoughtless masses an irrational dislike to foreigners, and an idea that their own countrymen are necessarily the most superior in the EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 35 world. Patriotism is not fostered by them solely as a feeling which leads to self- denial and disinterested effort for the whole nation, but as a curious mixture of a desire to overcome other nations, an irrational contempt for their customs, and a swaggering self-complacent idea of superiority. Sound patriotism — that is, love of the beauty of one's native country and its achievements in science, literature and the arts — is to be recommended and does not exclude the higher ideal — a love of humanity. The spurious patriotism promulgated by ambitious rulers and interested self-seeking classes seeks to foster dissension with other nations, and has only one purpose : to make obedient soldiers when the government of the country chooses to make war. If the well-being of one's country is threatened from without, it is an absolute duty to sacrifice oneself, but too often the interests of the rulers or ruling class are confounded with the State. Some persons have this feeling of attachment to home so well developed that they do not like leaving their native place and suffer from " home-sickness " when they do go away. The opposite are those persons who have no interest in home, take httle pains with it, and easily change to where their interest or business leads them. SOCIAL ATTACHMENT Animals having to fight to obtain food, and others having to defend themselves against attack, must have found it of advantage to keep together in groups, for aggression in a herd was surer of success than singly, and so was protection. Other animals found that by keeping in flocks mutual alarm could be given more easily ; also that enterprises, such as migration in the case of birds, afforded greater pro- tection when undertaken in a greater number. Similarly primitive man, un- protected against the forces of nature and at the mercy of every foe, his instinct directed him to cultivate the society of his fellows. He found that living in numbers and forming societies rendered him more powerful and enabled him to give effect to the advantage of his superior intelligence. Every conquest over animals and over natural conditions has been due to specialisation of employment ; and specialisation is not possible except in social life. When life is in sohtude, or in pairs, everything that is necessary for preservation and survival must be done by each individual or each pair. If every man had to collect his own food, protect his own family, build his own house, make his own clothes, and make his own furniture and utensils, innumerable works of utiUty would remain undone, and art, science, law, medicine, etc., would never have come into existence. Grouping among men was all the more necessary because of the long protection needed by their offspring. The long association before children became inde- pendent gave rise to an attachment between child and child, and child and parent, between brother and sister, friend and friend, and so on, thus forming the foundation of social life. Again, family life awakened in primitive man feelings of love and tenderness for those who excited in him no fear or rivalry. Gradually these sym- pathies widened till they embraced the tribe and ultimately the whole human race. Social attachment necessitates renunciation. To share the advantages, the protection, of the community, we must abandon the freedom allowable to a solitary man and restrain ourselves in every direction. Those who lack this sentiment are hkely to sacrifice friends if their interests should suffer. There is a great difference among individuals in regard to the strength of the social feeling. Some men have many acquaintances, but no friends ; while others remain attached to certain individuals during every change of circumstance, and do not readily enlarge the circle of their intimates. When this feeling is strong in a person, delight is felt in friendship and attachment. Those in whom the feehng is 36 ANALYSIS OF MAN'S PSYCHICAL NATURE weak care little for friends ; out of sight, out of mind, is their practice. The possession of this instinct, even in great strength, does not necessarily imply socia- biUty of temperament. Many a man in London leads a most solitary, unsociable life, who yet would find it hard to live far away from the thronged city. Such men are unsociable but gregarious ; and they illustrate the fact that sociability, although it has the gregarious instinct as its foundation, is a more complex, more highly developed tendency. However safe they may know themselves to be, most men find it difficult to sleep in an empty house, and would be distressed by prolonged absolute solitude. Even habit cannot do much in this respect. We like privacy, we do not like chatting all the time ; but we feel more comfortable in the knowledge there is another person somewhere on the premises. To a certain extent the foundation of all morality is domestic ; for even now, parental and conjugal sympathies, as they were the first to appear, so are they still the most fundamental. When a man has run his mortal race, if for his epitaph we may truly write that he was an affectionate son, a kind husband, and a tender father, we imply a character of fundamental goodness from which other moral qualities may be inferred. If we can add that he was a true friend and a devoted citizen, in that collection of parental, conjugal, and social sympathies we describe the full measure of ordinary practical morality. Living in crowds diminished the personal responsibility and increased the Suggestibility. Doing less for themselves, the keenness of the senses and the excellence of the reason in certain directions diminished, and belief in the collective observation and judgment was substituted. The masses cannot all take part in afiairs of the State and diplomacy, and must accept what the rulers choose to tell them through the Press. The information can be so restricted and so arranged as to create certain behef s and prej udices among the masses, and thus moulding pubhc opinion at the expense of independent judgment. In certain forms of insanity the social feelings become perverted, persons forming attachments to undesirables and outcasts, as in the early stage of mania and general paralysis ; or they become almost extinguished, solitude being preferred to company, as in melancholia, when even the death of a dear one may leave the patient indifferent. The melancholic shuns society because social intercourse gives him pain, while the paranoiac shuns it from mere distrust. The patient suffering from dementia prcBcox avoids relatives and associates, being engrossed with himself. Often the commencement of insanity is marked by the lapse of natural affection, the dislike of friends and relations becoming pronounced and increased to actual ■ hostility. Sometimes the mental disorder shows itself in patients loving without measure those whom they soon hate without reason. Long continued mental disorder is especially distinguished by an unsociableness, which often prevents patients from speaking to their companions. It is no pleasure to them to be associated with their fellow-creatures. Many of them do not play games, and they cannot combine for any purpose. SELF-REGARDING SENTIMENTS From the social attachment there arose the desire to please, to earn the approval of those who are dear to us and with whom we live in companionship. A man must so order his conduct as to gain the approval and good opinion of those with whom he consorts, and the desire of gaining and retaining this good opinion is one of the strongest of the motives by which his conduct is prompted and regulated. Such is the origin of love of praise and dread of blame, which are necessary elements in social life and give rise to the desire to excel — that is, to ambition. Duties are enjoined on the young by parents and elders ; and certain acts are forbidden or punished, others are applauded or rewarded. The public opinion of society carries on the process. EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 37 The desire to obtain the approval of others for our conduct, and to avoid their disapproval, is a very powerful and pervading motive to conduct. What will people think ? is a question constantly on the tongues of some, and constantly in the minds of all. In every community, conformity, not only of conduct, but of opinion, of each, with the conduct and opinion of the rest, is regarded with approval ; and conduct and opinion that do not conform to the common standard meet with strong reproba- tion, and sometimes with vigorous suppression. Hence we find strongly implanted among the instincts of every member of the community the desire to conform, to do as others do, to fall in with the prevailing mode of action. The good citizen is he who is satisfied with existing conditions and is obedient to authority. Conformity is the imitation of the example of others ; but there is a clear distinction between conformity and imitation. The child's action in learning to write is imitative, but it is not conforming. Conforming action is necessarily imitative, but imitative action is not necessarily conforming. Fashion is that conduct, whether changeable or continuous, to which all conform at the same time. Thus, a fashion, if it endures, becomes a custom ; and a custom, so long as it endures, is a fashion ; but, while continuity is the essence of custom, fashion is independent of continuity or change. Conformity to the customs of the community is usually regarded as morality ; but true morality is to do what we believe to be right, merely because it is right. We should disapprove of ourselves if we acted otherwise, and our own disapproval is more than we can bear ; so we do what we believe to be right, even though, in so doing, we incur the disapproval of others. Many people do not act on the motive of securing their own approval, but accept the conventional morality they find prevalent. Love of approbation causes men in their social intercourse to be courteous, conciliatory and polite. Life is thus made more pleasant, and the general sum of happiness is increased. If all men spoke exactly what they thought, without being restrained by the fear to offend, or the desire to please, what a world we would have ! Love of approbation gives rise to display ; thus refinement is promoted, and the dulness and ugliness of our surroundings are largely reduced. If it were not for the desire of approbation, how many books that interest and delight us would never have been written ! How many noble deeds would have remained undone ! Love of approbation renders people mindful of appearances, and often fishing for popularity though destitute of talents ; but when there is little love of approba- tion the person is indifferent whether he pleases or displeases, and, even possessed of talents, may have too little ambition to exert his powers. The reward of applause and the punishment of reprobation are a guide to conduct, and with many constitute a sense of duty. But this often leads to imitations of the general example and therefore does not deserve our approval, as when a person who has really little or no religious feeling is a regular church-goer, simply because he is afraid of his neighbours, or, for example, the man who is a Tory or Liberal in politics, because the one or the other party- view happens to be held by the majority, or, again, the person who subscribes to a charity not from a benevolent disposition, but because his neighbour has done the same. Such actions are not dictated by a desire to do good to humanity but are stimulated merely by a desire to obtain the applause of mankind. In obedience to the promptings of this faculty men will erect hospitals, endow universities, provide homes for the destitute. Many of our most noble institutions would fall into insolvency if all the contribu- tions to their funds which did not arise from a pure motive of benevolence were withdrawn. Benevolence alone would never do the noble deeds that the desire to please, to gain esteem, and to become notorious does. 38 ANALYSIS OF MAN'S PSYCHICAL NATURE From the desire to earn the admiration of one's fellow-men arose ambition, which we may define as that anxious aspiration, so characteristic of the human species, to rise above our respective station, or to attain to something loftier and, as fancy pictures, better than what we now enjoy. It implies, therefore, dis- satisfaction with the present, mingled, generally, with more or less elating visions for the future. There are persons with inordinate ambition, and appetite for honours which can never be satisfied ; feeding only serves to aggravate its hunger. No sooner has the ambitious man gained one eminence than another and yet loftier aim becomes visible, and with fresh and more eager efiorts and desires he strains forward to reach the summit. It is a continual restlessness, and each successful step increases the passion and renders its victim even less content and less happy than he was at the beginning. Ambition has two sources : the love of reputation and the love of power. Love of approbation confines itself to a narrow circle ; love ol reputation to a wider one, and is held to imply the possession of high intellectual aptitudes. Love of reputation in a high degree, over a wide area, and for a long period of time, is love of fame ; if the desire is merely to be talked about, it is love Of notoriety. Men may commit all sorts of actions to achieve that end. People with a disposition to plume them- selves on any petty, accidental, or temporary cause of superiority to their fellow-men are called vain. If the fear of disapprobation leads to confusion, we call it shame. It occurs on being discovered, but may be prospective and prevent us from doing things which are condemned by our friends or by public opinion. The social life led some men to comport themselves according to the ideas of others, but some became distinguished by preferring to act in acordance with their own views. They were men who set more value on their own opinions than on those of others. This gave them self-reliance and independence of character, self-con- fidence and self-satisfaction, which enabled their mental powers to act to the best advantage. These were the born commanders. The man who desires to rule is necessary to all organisation, political, military, or industrial. Just as the man who loves approbation is desirous of fame, so the man with large self-esteem loves power. The direction the love of fame or power will take is determined by the strength of the other faculties. Thus wealth, political or military fame, or even mere brute strength — in short, almost anything that can distinguish us from the crowd — may under different influences become the object of our aspirations. The civilisation of every country depends upon a small number of eminent men ; therefore the rest of us must have instincts and dispositions impelling us to follow leaders : such as suggestibility, imitation, admiration, etc. ; and will be progressive only when the rulers foster progress. The self-reliant man is well satisfied with himself no matter what his intellect, personal talents, birth or fortune ; he does not envy a king. On the other hand, those deficient in this respect wiU be remarkable for their humility. It is a wise provision of nature that persons in the meanest situations and with the humblest acquirements have a sense of self-importance. It renders its possessor happy and contented with that " modicum of sense " which has been conferred upon him, who otherwise would be miserable if aware of his deficiencies. It is sad to think that much talent has been lost to the world through self-confidence being too weak to enable the talented one to rise to the occasion and to fill a responsible office. We talk a great deal of Hberty, forgetting the fact that obedience is an impulse which gives restful happiness to millions of mankind. Many a slave has been freed that would have preferred to remain with his old master. Love of liberty may be regarded as the counterpart of the love of power. As the EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 39 superior desires power, so the inferior desires liberty — that is to say, emancipation from the power of his superior. Where the power of which the exertion is resented is moral and not physical, the appropriate phrase is not love of liberty, but love of independence. Self-esteem in excess leads to conceit and arrogance. Self-esteem is often exaggerated to the ridiculous, sometimes with reference to personal attractiveness, sometimes in regard to intellectual ability. The " bore " has plenty of it. Some men are successful in life through sheer " cheek." Where our regard for self keeps us from performing certain actions deemed unworthy of ourselves, we call the attitude self-respect. But what we consider unworthy is, for most of us, determined by what our social environment considers to be unworthy. What is ordinarily called self-respect really is dependent, in the great majority of cases, on what people generally think regarding such matters. Self-esteem and love of approbation are often confounded. By the one senti- ment a man esteems himself ; by the other he courts the esteem of others. They are best distinguished in their abuse. The one is pride, the other vanity ; the one assumes, the other begs ; hence it is truly remarked that an individual is too proud to be vain. Pride is more connected with command, and vanity with taking counsel. The vain man attaches the utmost importance to the opinions entertained of him by others, and seeks with eagerness to gain their approbation ; the proud man expects that mankind will come to him and acknowledge his merit. The vain man knocks at every door to draw attention towards himself, and supplicates the smallest position of honour ; the proud man despises these marks of distinction, which on the vain confer the most perfect delight. The proud man is disgusted by indiscreet eulogisms ; the vain man inhales with ecstasy the incense of flattery, although pro- fusely offered and by no very skilful hand. Some people have so httle self-esteem and are so sensitive to criticism that they anticipate it keenly ; they become morbidly shy and shun society. They are too self-conscious. Of course, the emotion of fear is mixed up with it ; but it is not merely fear of adverse criticism ; they are also shy of praise, and begin to blush all over. It is not always a sense of their own inferiority, for people who are convinced of their own capacities and have confidence in themselves in other ways, as in their writings, yet evince that shyness before strangers. Sh^yTiess is natural at pubert}^ and is then the outcome of the growth of the sex instinct. In women, one takes it perhaps as more or less natural. Men afflicted with this complaint feel it more keenly. They feel it when in comjeany as if they were always observed and are doubtful that the observation may not always be sympathetic, or else they are eager to make a good impression and consequently become nervous. A shy person may blush, get confused, have tremors, show restless movements, have a nervous laugh and a foolish expression, with the eyes glancing restlessly in all directions. He sometimes tries to hide his discomfort. In con- sequence of these feelings, he isolates himself from society and even ordinary companions sometimes, and becomes a lonely man, with all the evils of self- contemplation, self-introspection, eccentricity, etc., that are apt to develop in the recluse. Self-conscious people find it difficult to walk across a stage when hundreds of people are looking, or to address an audience of strangers eagerly listening to them. They become awkward and embarrassed under the circumstances. Self-reliance imparts a resolute character, not easily influenced by others ; the helpless man lacks constancy, for his actions depend on the influence of others, his conduct is therefore not uniform. Belief in one's own powers gives tenacity of purpose and firmness ; if in excess, stubbornness and obstinacy. Some persons yield readily ; it may be said of some they scarcely have a will of 40 ANALYSIS OF MAN'S PSYCHICAL NATURE their own ; they follow the last impulse they receive, and, without strength to resist, they are easy instruments of all whom they meet. They give up persevering under difficulties ; they decline to follow the estimable motto, " Try again." Others are of an immovable character, firm in their resolutions and constant in their principles ; they do not attend to exhortations or to examples ; their conduct is uniform, and their exertions may be calculated on in various situations of life. Some persons are steady, determined, persevering in character, others vacillating, lacking fortitude and patient endurance. The greatest work demands the greatest effort ; and not only so, but this effort must be perseveringly applied, and for this firmness is necessary. When firmness is deficient, the individual is the victim of those external circumstances that may address his strong faculties, and no confidence can be placed in him, for what he says or does to-day is no guide as to what he will do to-morrow. Stability of character is often called Strength Ol will. A man who adheres tenaciously to his resolutions is called a strong-willed man, and, if this tendency exists in excess, an obstinate man. On the other hand, a man who vacillates, or frequently changes his resolutions, is called a man of weak will. Some men are by nature resolute and consistent, and are therefore credited with great will power. They refuse to be the sport of circumstances, to drift with the current, but strike boldly out for some definite point on life's shore. How came they by that tenacious- ness ? What were the exterior circumstances that gave to it its tone and direction ? Such will power and tenaciousness will be found in most cases to be hereditary, and as regards its scope and direction only shall we find it the sport of circumstances. Small minds often exhibit a tenaciousness that leads them to success, for they are capable of being entirely possessed by the one unchanging motive. Larger minds often fail of success by reason of a want of consistency in pursuit due to the varied play of many motives, each capable of a strong attraction, on a richly endowed nature. It is the person who has definite aims in life who will appear to possess the strongest will. The habit of perseverance or of continuous effort is that which, added to energy, constitutes industry. Patience is passive endurance of labour, but also endurance under fatigue and suffering in general. Persons with large self-esteem have confidence in their own powers, value their own judgment, and are willing to assume responsibihty. If intellectually gifted they may undervalue the talents of others ; and with small intellect there may be a conceit of abilities not possessed. WTien there is httle self-esteem, a person gives in to the judgment of others easily, lacks independence, self-confidence, natural dignity, self-rehance. And if given to respect authority as well, he is liable to underrate his own abihties, and more apt to follow than to lead. Little self-esteem in a cautious person is likely to make him afraid to exert himself ; but, gifted intellectually, he may lead off well when once placed in a responsible position, though at first he distrusts his own capabihties. Self-esteem and self-satisfaction are prominent in the early stage of mania. Such patients admit only their own point of view and their own plans. A silly self- satisfaction is noticeable in the alcoholic. On the other hand, self-esteem is dimin- ished and there is a feeling of unworthiness in melancholia. In general paralysis the patient beheves himself to be an exalted personage, but he changes his character almost daily, if not hourly, being one moment a great general, another a king or statesman, a third a milhonaire or a strong man, giving ample evidence of the weakening of his intellect. In the later stages of paranoia the patient also beheves himself an exalted personage, often an under-rated genius, but the character he fancies himself to be is fixed . He knows he is an important person ; he can tell you EVOLUTION OF THE EMOTIONS AND INSTINCTIVE IMPULSES 41 good reasons why. His intellect is perfectly retained, although he reasons from false premisses. Generally speaking, amongst the insane we meet with men immensely over- estimating their own importance and the significance of all their actions, engrossed only with themselves, and but little, or not at all, with external things. CHAPTER XXVII EVOLUTION OF THE INTELLECTUAL CAPACITIES AND THE ETHICAL, .^STHETICAL, AND RELIGIOUS SENTIMENTS Man possesses, in addition to the feelings and propensities he has in common with animals, intellectual powers of superior order and higher sentiments which are pecuhar to the human race. Man possesses various elementary capacities which constitute his observation, memory, reason, and imagination. According to the degree of their development, so is the intellect of the individual petty or great. Among the ignorant we find defective and inexact observation, influenced generally by the emotional prejudices of the observer ; weak, or what is even worse, misleading memory ; feeble reason, dependent on faith in authority ; and hmited imagination. Much has been written concerning the extent of human ignorance ; but we ought to discriminate between absolute incapacity to know, and mere want of information, arising from the fact of not having employed this capacity to its full extent. Man is endowed with intellectual faculties, and these may be divided into the knowing and reflecting. It is undeniable that intellectually we know and we reflect. It is a common observation that knowledge is not wisdom till it is compared and reasoned on by reflection. It is its combination with reflection which constitutes that knowledge which is power. The weakest reflecting powers often co-exist in the same individual with a store of knowledge which excites our wonder. Few men are equally good in reasoning and observation. There are men of observation and men whose knowledge rests chiefly on reason ; the former are more practical, the latter more theoretical. Our ability to perceive, to reason, to learn certain subjects would not be exerted without the instinctive impulses, the needs of the organisation.which are driving forces to the employment of the intellect and give rise to curiosity. At first the intellect is confined in its range by the fears and wants which an object and necessitous condition prescribe to it ; but as curiosity is enlarged, it devises means to ends, rising continually higher and higher, and developing the several arts and industries necessary to the convenience and adornment of life. POWERS OF OBSERVATION AND REMEMBRANCE Animals possess curiosity and powers of observation often to an extraordinary degree. The desire to obtain food induced them to examine everything of novel appearance which came within their range of observation, irrespective of its utihty. Curiosity to observe, especially anything unfamihar, is common to all animals, and their educabiUty probably depends on the strength of it. The connection between memory and sensory impressions is of the very closest. Indeed, our faculty of perceptive sight results from an intimate combination of sensory recollections with sensory impressions. Memory apart, sensation would EVOLUTION OF THE INTELLECTUAL CAPACITIES 43 mean nothing to us. Men with sight only could see, but would not perceive. Men with hearing only would hear, but would not understand. There is no sensation that can be appreciated without recollection. There is no sensation which does not call up recollections. It is beyond dispute that the powers of observation are the primary faculties of intelligence, and supply the raw material, as it were, for all intellectual exertion. They include retentiveness as well, and supply the material for practical knowledge. Memory, hke perception, is not a single faculty, but there exist perceptions and memories for words, sounds, numbers, lapse of time, order of sequence, space, form, distance, colour, weight, objects, places, of different strength in each individual. Each of them may be lost in circumscribed injury or disease of the brain (see Chapter XXIX.). On these conceptions, in part, the talents of drawing, painting, sculpture, mechanics, music, etc., depend ; and from the desire to know objects as mere existences our inclinations for the study of science arose. Our perceptions and memories may be divided into those of mere existences — stationary objects — and those for moving objects or objects in time, i.e., for facts and events. The knowing powers cognise two classes of objects, existences and events — in other words, things that are, and things that happen. Let anyone reflect for a moment and he ^\ill find that whatever he knows must either have an existence or be an event. The paper on which we write is an existence — a thing that is ; if Ave drop it on the carpet, it is an event, a thing that has happened ; a change has taken place. Soldiers are existences, their battle is an event. The acids and alkaUs are existences ; their effervescence or mixture is an event. Natural history concerns existences ; ci\al history records events. Now, from observing that the power of perceiving and remembering these two classes of objects, respectively, varies in a marked degree in different individuals, and that they may be lost independently of one another in lesions of the brain, we may consider them as distinct. Speaking generally, a man with good perceptive powers is Ukely to be an observer of men and things, a practical man given to minute inspection and adapted to study physical phenomena. Combined with the acquiring instinct, he is likely to interest himself in the value of property and goods ; and combined with constructive abihty, he \vi\\ be given to mechanical operations and interest himself in machinery, A man with good perceptive powers but small reflective capacity will be a man of facts rather than ideas, better adapted for carrying out plans than for originating them. He -will be a man who looks more than he thinks, of quick perception but possibly little wisdom, a man who thinks nothing is certain and worthy of attention except facts. Good perceptive powers combined vnth good reflective powers make a man not only a close observer of things, but also strongly incUned to trace their relations of cause and effect. A man with small perceptive powers will be deficient in the capacity of observa- tion and take little interest in the mere examination of objects ; and with superior reflective power, he Avill be more of a philosopher than a scientist, a bookworm rather than an experimenter in the laboratory. That is to say, he is most likely to be these things ; his tendencies \vill run in these directions. Each of the perceptive powers and memories will now be dealt with in detail ; and we shall show in a later chapter that each of them depends on a definite centre in the brain and may be lost when that hmited brain area is injured or diseased. The perception and memory of form is commonly accepted as an elementary power. We all vary in it, as, for example, in its application to the remembering of faces. It is said of Cuvier that he was able to recognise a similarity in form in the most extraordinary manner, never forgetting the shape of an object he had once seen. The special memory developed by this faculty is also well illustrated by those artists 44 ANALYSIS OF MAN'S PSYCHICAL NATURE who are able to draw accurately from memory ; thus it is said of Turner that, having carefully looked at a ship, he was able to go home and draw from memory the details of the ship as accurately as if he had been standing in front of it. The power to observe the size of objects is another elementary capacity. Its function is manifestly different from that of the faculty of form ; thus a sixpence and a half-crown are of the same form, but differ in size. Another is the power of resistance or sense of weight. The perception of position, giving the memory for places, or the sense of locality, varies greatly in people. It is not dependent on any sense in particular. Locality is a faculty (probably complex) which appears to be more developed in savages and animals than it is in persons belonging to civilised communities. It is also larger in a provincial dweller than in a citizen of a large town, as we should naturally expect. An animal or savage would soon get lost in the forest if it were not for this faculty to guide them back to their starting-point. The ability to deal with numbers, being a natural power, can, of course, like any other, be improved by exercise and practice, but no amount of practice will produce it where nature has not bestowed it. It, too, depends on no sense in particular. It is with this faculty as with all others : great ability in regard to numbers and calculation gives a great love for them. Another elementary power is that of perceiving periods of time, forming a sort of natural chronometer in the individual. It likewise depends on no sense in particular. The special memory is well seen in those persons who are able to remember the chronological order of events easily, because they are associated with ideas of periods of time. It is surprising how accurately some men are able to tell the exact time of day without referring to a watch. Time in music also comes under the same faculty, because here a correct estimation of time has to be formed, so that the notes may be played in correct relation to the time as shown by the metronome. Though the perception of time is essential to a musician, it does not make a musician ; several other qualities are required, which vary according to the type selected. A person with a small development of tone-perception thinks music a " noise," and takes no pleasure in it, not being able to distinguish one tune from another. To the unmusical person a Mozart or Beethoven concerto is only horsehair scraping on catgut ; whereas Heine rapturously declared that Paganini's violin expressed " sounds from whose bottomless depths gleamed no ray of hope or comfort . . . melting sensuously languishing notes of bliss ! Tones that kissed one another, then poutingly fled from one another, and again languishingly embraced and became one and died away in the ecstasy of the union." The memory for words is probably very complex. A man may have an excellent memory for languages and yet a poor memory for proper names ; he may be fluent in speech and yet have a very small vocabulary. His visual memory^ i.e., memory for things read, may be excellent ; and his auditory memory, i.e., his memory for words heard, may be very poor, and the reverse. It is doubtful to what extent ideas are formulated and exist in the mind in the shape of words — to what extent, that is, men think in words. There can be no doubt of the existence of thought in the lower animals, and that they can express their emotions and communicate them, and it is equally certain that all normal children have a copious supply of thought before they have any knowledge of EVOLUTION OF THE INTELLECTUAL CAPACITIES 45 language at all adequate for thinking in words. The difficulty many people have in expressing their thoughts, and which even the most fluent speakers sometimes feel in putting into words certain ideas, is a further proof of at least a very considerable independence between ideas and their verbal formulae. Gambetta, as we have shown (Vol. I., p. 396), had a wonderfully developed speech centre, a better machinery for remembering and speaking words than the average man. The rest of his brain was comparatively small. He was a great speaker, because he was born with the tools to speak with, but he was not brilliant in other respects ; just like some members of our own Parliament. The speech centre by itself is usually not of much use, unless a man has the intellect correspondingly developed. Just as a great painter, who was asked what he mixed his paints with, was correct in replying " brains " ; for without brains the sense of colour alone is useless, so it is useless to have the speech centre by itself. We see, then, that neither perception, memory, nor judgment are elementary powers of the mind. When one is said to be a man of quick perception, or of good memory, or sound judgment, we must ask — of what ? It is a metaphysical error to distinguish memory as a primitive faculty. If memory were a distinctive power, it would in each individual be alike strong, and regard all subjects of recollection alike. But as this is not consistent with fact, as one individual remembers existences and another forgets existences and remembers events, while a third recalls with ease a train of reasoning, another musical airs, and another faces he has seen, or scenes he has surveyed, each perhaps weakly remember- ing something else of the matters enumerated, we are forced to the conclusion that there is no general faculty called memory, but that each faculty has its own power of recalling its impressions. The instructor of youths should ponder this truth well, and he will save himself and his pupil much time and labour in indefinite and desultory exercise of a supposed general faculty of memory, when in truth he ^vill actually improve the memory of each mental power in the proper direct cultivation of the power itself. We have not only " intellectual " memories, but also memories of our emotional experiences and the actions of our propensities. Of course, the latter are never pure memories, but are connected with the ideas we had at the time when we had the emotions and exercised the volition. That the emotions and propensities influence our memory is shown by the fact that the timid man will remember the objects and events which inspired him with fear better than other facts ; the acquisitive man will remember all that concerns money and business ; the secretive man all that aroused his suspicion, and so on. Nothing is ever absolutely forgotten, once it has been impressed upon the mind. No impression, once recorded, ever ceases to exist. It is not lost, but merely becomes obscure and exists outside of the field of consciousness, to which, however, it may be recalled long afterwards by some act of the will, or some association, accord- ing to the circumstances of the case. It is true that many impressions are never revived, either by voUtional effort or involuntarily through association, but the impression is there still and its influence is manifest in our acts and thoughts. Attention is necessary to memory. The remembrance of anything depends upon the clearness and vividness of the impression originally made by it upon the mind, and this on the degree of attention with which it was regarded. The defects of memory, of which most persons complain, are owing more to want of attention than to any other cause. We remember what we attend to, but what we do not attend to we readily forget. Attention is the fixing of the mind intently upon one particular object, to the exclusion for the time of all other objects that solicit its notice. It is not, strictly speaking, a special faculty of the mind, but is a mode of activity equally appUcable to all its states. We pay attention to what interests us — one to business. 46 ANALYSIS OF MAN'S PSYCHICAL NATURE another to music, another to science, etc., and therefore according to the natural dispositions for these subjects, so will be our attention and memory for them. We cannot separate our world from our interest in it. What we see in it is determined by our attention, and our attention is determined by our organic needs and interests. Indeed, one individual differs from another not so much in power of memory, reasoning, attention, or wiU, as in the sort of material to whichhe successfully applies these processes. It is commonly said that in the decay of our powers through age the memory is the first faculty that fails ; but this is not strictly correct, for it is the power of attention, on which memory depends, that is the first to deteriorate. Hence it is the most recent subjects — the things of yesterday or last week — those that have not been sufi&ciently attended to, that are the first to disappear. The things of years ago, and of early life, those that were attended to and are estabhshed, are the last to be forgotten. Another factor is that in old age our interests diminish, the elementary passions fade, and so we regard with less attention the objects and events before us, and remember them afterwards imperfectly, if at all. Attention undergoes pathological alterations in insanity, varying from the painful monoideism of the melancholiac to the maniac's rush of ideas. Memory must be clearly distinguished from remembrance, recollection, and recognition. Memory is the innate power to have an impression recalled if a proper stimulus be applied. Recollection is the power of voluntarily recalling impressions, using an effort of the wUl, to revive some impression previously stored away. Remembrance is the term apphed when the process is involuntary, when the pre- viously stored impression comes again into the field of consciousness without an effort of the wiU, as by association, resemblance, etc. Recognition is the word applied to that process of the memory whereby, when we see or hear a thing, we know that we have seen or heard it before ; it is a conscious association of the present impression with previous ones. Recognition is therefore the essential element of memory. REASONING POWERS The power of reasoning upon the knowledge gained, of tracing the relations of cause and effect, and of determining the analogies which obtain among other things dissimilar, comprises the next development in the intellectual capacity. The process of reasoning, of drawing conclusions, is sometimes performed by a simple act of comparison, or perception of analogy. A vast majority of mankind reason in this way. The whole of the briUiant field of what in reasoning is called illustration is nothing more than this process of comparison. Another set of reasoners are more severe and are contented with no conclusions which do not stand in the relation of necessary consequences to their premisses. This is truth, they reason, because it is deducible necessarily from the consideration of these other known truths brought together. These are the logicians, who distrust analogy and comparison. The faculty they use is the highest intellectual power, the percipient of the relation of cause and effect. It is clear, then, that the act of meditating can be performed in two distinct ways, by induction and deduction. Inductive meditation is to institute comparisons and to generalise. It is found in persons highly critical, in those fond of metaphors. An intellect given rather to deductive meditation is an intellect which co-ordinates, systematises, and draws consequences. Both forms of meditation may be equally active, but there are exceptions — to wit, the bom critic on the one hand, and the philosopher whose mind is in quest mainly for cause and effect. A person with dominant reflective faculties is generally gifted with depth of reasoning and strength of understanding ; and if he is poor in powers of observation. EVOLUTION OF THE INTELLECTUAL CAPACITIES 47 he will be more deep than clear, more theoretical than practical, better in philosophy and speculation of human affairs than in the details of science, likely to make good plans though he may be less good in putting them into practice. He will possess an inquiring and investigating turn of mind, good judgment, originality, able to clear up abstruse points and to carry conviction by irresistible arguments presented in a very intelligible manner, especially if he have the gift of language as well. With the combative instinct, he will be able to advocate and defend his opinions vigorously. A person with little reflective power will think Uttle in the abstract, will not be clear or correct in apprehending the principles of causation, will be deficient in discernment and understanding and injudicious in planning. Persons with small reflective power frequently have great faith in authority, and reason thus : A = B, because C said so. Such people, for example, judge the merits of a book by its circulation, just as they do the wisdom of a man by the income he earns. Small reflective powers combined with a tendency to imitation renders a person apt to do what he sees others do ; he may gain something from experience, yet will be un- wilhng to apply his mind to any subject requiring close investigation and research. Little reflective power combined with selfish propensities and some secretiveness render a man shrewd ; he may manifest considerable tact and ingenuity in laying plans, yet he has too Uttle intellect to realise them. A person possessing good inductive capacity will be keen in discrimination, and will rarely fail to catch points of difference. Good at analogies, he will readily discover resemblances and differences and will possess a criticising turn of mind. If he have good perceptive powers as well, he will be good in comparing natural phenomena and in illustrating his ideas. With aesthetic sensibility, he will make many elegant and elevated comparisons ; and with small aesthetic sensibility, he will be more argumentative than ornamental in illustration. Altogether there are three degrees in the reasoning capacities of mankind. One man understands things by means of his own natural endowments ; another under- stands things when they are explained to him ; and a third can neither understand them himself, nor when they are explained by others. It is commonly assumed that ignorance keeps people poor, but this is not the case. We are all ignorant in certain things. Only one thing is true, that ignorance leads to the exploitation by the unscrupulous. Persons of little education, but knowing how to make the most of that little knowledge they possess, often succeed wonderfully. * Insanity is primarily a disturbance of the feelings and consequently of the conduct of man. The brain disturbance must be serious before the intellect shows permanent signs of weakening. But there is often a want of power of fixing the attention and loss of memory, the most common affairs of life being forgotten, names, dates, figures, passing out of recollection. When perception is disturbed there may be hallucinations and illusions ; when the reasoning powers are weakened there may be disturbances in the formation of ideas, of the train of thought, or its rapidity. \Vhen the accuracy of memory is disturbed, we see the patient unconsciously distorting facts when telling them, or he may mix real experiences and imagined experiences together without knowing it, or he may deal in fabrications which are really hallucinations of memory-, the patient weaving an account of things often improbable and contradictory, that never existed, yet doing this all unconscious of the untruth. Normal and abnormal defects of memory are, of course, a matter of degree. No one remembers all his experiences, and to forget is as natural and as normal as to remember. In practice, however, little difficulty is experienced in deciding that a defect of memory is morbid in degree, since by common consent no defect is considered morbid if not extreme. 48 ANALYSIS OF MAN'S PSYCHICAL NATURE Loss of memory is often very marked in insanity. The power of recollection — especially of recent events — disappears or is considerably diminished in general paralysis and in senile dementia. At the commencement of the former disease there is forgetfulness of ordinary duties and of details of business. Sometimes the recollection of former years is present, but no recollection of what has happened half an hour before. Sometimes also there are delusions of recollection on account of the memory picture being insufficiently fixed. Or events that never happened are remembered as realities. On the other hand, a very profound degree of apparent dementia is not inconsistent with an almost perfect recollection of events. The memory is impaired in chronic opium poisoning, and more so in chronic alcoholism, where there is instantaneous forgetfulness of events which have only just transpired. On the other hand, in the early stage of mania the memory is stimulated, so that the patient may be able to recall whole pages of poetry or to quote extensively from standard works. The commonest forms of sense delusions are hallucinations and illusions. The essential difference between the two is that the hallucination is solely a brain creation without any external stimulus to produce it, whereas an illusion is aroused by some real object outside the brain, and is, in fact, a misinterpreted sensation. Sense deceptions may occur in the sane. Their importance as a disease sjonptom in insanity rests on the fact that they exert a powerful and irresistible influence over the entire thought and activity of the patient. Hallucinations depend upon disturbances of the centres of sensation, so that the person may hear, see, taste, and feel things which have no external objects to evoke them ; and yet so vivid is the impression made upon him, because of some abnormal excitation in his brain-cells that are ordinarily excited by real objects, that he feels certain that the things heard, seen, etc., really exist in the world outside, though in truth they originate in his own brain. Suspicion of insanity is always excited if hallucinations are present. Hallucina- tions, which occur also in fevers and intoxications, are not in themselves decisive as to the existence of insanity. The most that they prove is the existence of an abnormal cerebral condition. Hallucinations appear in their true light only when they stand in relation to other elementary disturbances, such as attacks of anxiety, and in the disturbed state of consciousness are no longer corrected and exercise influence on action. Hallucinations of all the senses may occur at the same time, or there may be disturbances in only one or two fields. They may be agreeable, but more often they are disagreeable. Unpleasant hallucinations often give rise to dangerous conduct on the part of their victim. Hallucinations of taste are frequently found with delusions of poisoning. When the sense of smell is affected patients frequently complain of foul odours, of gases being forced into their sleeping apartments, and such complaints are not uncommon with certain forms of persecutory delusions, which are largely based upon them. Hallucinations of sight are particularly characteristic of toxic interference with cerebral action. They are common in all forms of alcoholism, in poisoning by various mineral and vegetable drugs, in exhaustion, starvation, and long-continued thirst. Hallucinations of sight occur in acute mania ; horrible scenes are witnessed in the hallucinations of melancholia ; repugnant objects in motion in acute alcohol- ism ; fear-inspiring visions occur in inanition delirium, and frightful hallucinations in puerperal mania. Insane epileptics, too, are sometimes subject to terrifying hallucinations, and ecstatic visions are sometimes seen by hysterical women. The most common hallucinations are those of hearing. The patient hears voices, and generally words expressing definite ideas, though he is often unable properly to refer them to any speaking person. Sometimes, instead of external sounds or voices, the patient has a consciousness of an internal voice that may be as real to him as any external auditory perception. Their utterances may be EVOLUTION OF THE INTELLECTUAL CAPACITIES 49 agreeable, but it is more often the case that they are abusive, threatening, or commanding, and annoying or absolutely distressing to the patient. The belief in their reality is so general that they are a positive source of danger, for one day the subjects may be able to control themselves and disregard the " voice " ; the next, they may feel bound to obey the voice and do what it commands, whether it be homicide or suicide. Hearing voices is often the first sign of brain disturbance and can remain stationary for years ; but for these voices such people may be in all respects sane, and conduct themselves as ordinary members of society, yet they are always to be looked upon with suspicion. Abusive and threatening voices are commonest in paranoia ; they are constant and follow the patient wherever he goes. Besides the deception of the special senses, there are also found in the insane hallucinations of general sensation and visceral feeling, as well as of the cutaneous surfaces. Illusions are also deceptions of the senses, but they have an outside object as a starting-point. An illusion is a false perception. The object is not recognised in its real character, but is perceived as something else. The patient really hears, sees, tastes something, but thinks it is other than it is. He misinterprets it. His sense impressions are as correct as ever, but the judging power is at fault. Some persons may experience illusions, but by bringing closer investigation and judgment to bear on them they are able to correct the false impressions ; the sane man compares the visual object of delusion with the impression of other senses and the perceptions of other persons ; this is exactly what the madman cannot do. He concludes that what is only an illusion is a reality. But the illusion is not the madness. The madness hes in the want of power or resolution to examine. He is insane because he meditates and indulges in the morbid sensation, which thus acquires fresh force. The illusion, like the hallucination, may be of a pleasant or unpleasant character. Illusions of sight are the most common in the insane. Next to illusions of sight come probably those of hearing, and all the senses may be thus subject to mis- interpretation in states of mental disorder. A very striking class of illusions is that of the internal or visceral sensations ; a vague bodily sensation is attributed to some special cause — such as having a snake in the abdomen — altogether different from the reality. When insanity affects the intellectual sphere, ideation suffers. There may be abnormally slow thought, or absurdly rapid thought, or such a flight of ideas that the association between them can no longer be traced by the bystander — the stream of thought has become incoherent. The insane do not differ from the sane by the apparent loss of the faculty of reasoning ; but having joined together some ideas very wrongly, they mistake them for truths and they err as men do who argue right from wrong principles. Of course, there are insane who both reason illogically and incoherently, and establish wrong premisses from which their reasoning proceeds. A marked feature of impending mental disorder is seen in the tendency to allow the mind to wander away from the proper duties of Ufe, and luxuriate among scenes of the imagination, or of ill-regulated fancy, becoming dreamy and abstracted. Abnormally slow thought, giving rise to dearth of ideas and expression, occurs with a depressed emotional state, as in melancholia. Abnormally rapid thought, a rapid flow of ideas, occurs in mania, and becomes more and more jumbled in ex- pression as the disorder progresses ; this latter condition is accompanied by an exalted emotional state. The rapidity of thought may increase to such an extent that the patient loses the thread of conversation, he is no longer able to arrange logically the abundance of material that comes to him, but he expresses senseless ideas, disconnected sentences, words, and syllables. Since the flash-like ideas can Vol. ii.] E 50 ANALYSIS OF MAN'S PSYCHICAL NATURE no longer be co-ordinated or placed in logical sequence, the result is incoherence. Incoherence of thought and speech is, however, not exclusively the result of increase of thought or a symptom only of maniacal states. It occurs also in various other abnormal conditions. WhUst rapidity of ideation leads to verbosity, slowness of ideation induces taciturnity. The person speaks only after long pauses and much hesitation, in a subdued voice, and only in response to very strong stimulation, or to categorical and persistent questions. In the early stage of mania the acceleration of ideas is, at all events at first, so sli2;ht that the patient may gi\e the impression of being an entertaining con- versationalist, full of spirit, wit, and humour. It is in acute mania and in acute alcoholism that the ideas are confused, and often there is a repetition of ideas. The intellect is restricted in epileptic insanity ; there is mental enfeeblement in chronic alcoholism and progressive mental weakness in a formerly clever youth occurs in dementia prcecox. In melancholia the intellect also remains clear, its processes are only retarded, because thinking becomes painful, so that the ideas do not flow, the response to questions is slow, and patients are incapable of long sustained mental efiort. Abnormal slowness of ideation occurs also in states of mental weakness. The most marked derangement of ideas is of course in dementia. A lack of ideas is characteristic of idiocy and imbecility from arrested brain development, and since the intellect acts as an inhibitory force and checks the animal passions, there is lack of self-restraint in the weak-minded. As regards his stock of ideas, the imbecile has been described as a pauper, the dement as a bankrupt. Their intellectual level is the same, but the one does not rise because he is unable to learn, the other fails because he has unlearned what he knew. The imbecile is and remains mentally a child, but the dement retains from his bankrupt stock remnants of developed intelligence. Day-dreaming is done by the sane and overdone by the insane. It is fraught with serious mischief to the mind. There is pleasure attached to its illusions, which renders it seductive and dangerous. Great activity of the imagination regularly accompanies an increased susceptibility of thought to external causes and sus- ceptibiHty to auto-suggestion. Mental abstraction occurs in hysterical insanity, and day-dreaming and immature philosophising in dementia prcecox. MANUAL DEXTERITY AND CONSTRUCTIVE CAPACITY Man and some other animals have the ability and desire to build both a home and a place for their store of savings. With the advantage of manipulative organs and a progressive brain, man gradually developed a capacity to understand and to utiUse the forces of nature. As a handicraftsman he fashioned tools and weapons, with the skilful use of which he got the mastery over all other animals. With a knowledge of the uses of fire, the art of cooking his food, and the power of fabricating materials for clothing his body, he accommodated himself to the vicissitudes of cUmate, and so greatly extended his habitable area on the globe. The element of conscious constructiveness appears to be manual dexterity, and it reaches its zenith in the inventions of art and industry. Children frequently excel in fashioning a variety of figures of animals and things long before their understanding is matured. Idiots have been known to excel in mechanics ; while some men of great talents have been unable to fabricate or construct. In short, the fact is undeniable that genius for works of art is not possessed in proportion to the strength of the understanding. Constructive abihty with large perceptive powers gives talent for drawing, modelling, planning, and inventing. With aesthetic sensibihty as well, there is passion and ability for the fine arts. With the constructive tendency, but small powers of observation, the person may understand machinery but will be awkward EVOLUTION OF THE INTELLECTUAL CAPACITIES 51 in the use of tools. The study of machinery has no interest for the man who has little constructive abiUty, but if he has good powers of observation and imitation he will be able to learn to do what he is shown. If of good intellect, but without any mechanical talent, he may still be able to direct others. IMITATION Imitation is another natural capacity, by which a large portion of the experience of infancy is acquired. Children imitate their elders, and thus is preserved the continuity of manners and tastes from one generation to another. To this pro- pensity the family and the nation owe most of their external uniformity in dress, manners, and culture. Paradoxical as it may appear, it is only the imitative mind which can attain originality ; the artist must learn to copy before he can create. The tendency to reproduce with the hand whatever pleases and astonishes the mind undoubtedly began at an early period in the history of man. The faculty of imitation is often defective, and is sometimes in excess. There are many occasions on which imitation cannot be achieved, either at all, or without much labour, and many unsuccessful attempts, as every teacher of handicraft and bodily exercise knows. The power of accurate imitation diminishes with advancing years and differs much in different people. While a strong tendency to instinctive imitation is a sign of a mind of low cahbre, some forms of imitation, as, for instance, the subtle imitation in high-class parody, of the spirit as well as of the form of the original, demand faculties of a high order. Mere instinctive imitation is seen at its height in monkeys. The power of imitation is essential also to the mimic. Persons without intellect, children, and idiots are sometimes very clever in imitating the facial expression and manners of people with whom they come in contact, which shows that it must be a natural gift independent of the understanding. When there is httle gift for imitation and considerable self-esteem, a person will not try to imitate other people, but v.'ill have Uttle incUnation to adopt other people's ways and opinions, and will prefer to go his own way. /ESTHETIC SENSE Another power of the intellect is that of synthetising and creating. From the moment of the creation of language, the intellect is able to pass from the useful material creation to a disinterested creation ; from the day on which it perceives it Can work in the abstract it gives itself up to the creation of ideas. The synthetic creation of ideas is a characteristic of mankind, and especially useful to the poet and artist, but the scientist also cannot do without it. Many people possess the power but cannot give expression to it. This power of inventing scenes or objects invested with the quaUties most pleasing to ourselves is called the cssthetic sense, or faculty. The aesthetic faculty is manifested in aptitudes which range from supreme talent in artistic expression to an absolute insensibility to beauty. It is, of course, independent of the power of production. It may manifest itself in mere apprecia- tion. For one creative artist there are thousands of admirers of art. Man, unhke animals, can enjoy things apart from their utility, merely for their beauty. This is not the effect of intellect, for highly intellectual persons are often very poorly endowed with it. Two men with equally good eyes may perceive an object, but only the one with the aesthetic sense will seek for grace, elegance and beauty and enjoy them when observed. Poets and artists possess this aesthetic sensibUity, and also many other persons who lack the other powers by which they might give expression thereto. Such persons long for something more perfect than the scenes of mere reaUty ; a plain, unadorned description of things would not 52 ANALYSIS OF MAN'S PSYCHICAL NATURE satisfy them. They love the ideal and are enthusiastic in their appreciation of whatever manifestation of it may appeal to their natural aptitudes and dispositions. A certain proportion of the spare energy, left over after vital requirements are satisfied, is expended on the contemplation of beauty and the making of beautiful things. The contemplation of beauty, and the measures taken to go where beautiful things are to be found, constitute one phase of aesthetic conduct ; the making and acquisition of beautiful things constitute another. Some hold that the aesthetic sentiment is akin to play. They see a play at human passions in poetry and the drama. But there is more truth in saying that imitation is akin to play, as we see it illustrated in the conduct of children. The play instinct is possessed by both animals and man, but is not an instinct in the proper sense of the word. It arises from the pleasure that exists in activity, provided the activity be spontaneous and consist in the normal exercise of the faculties. That it is not only imitative is shown by boys and girls not imitating the same thing. The feeble-minded are usually entirely without aesthetic sensibility, yet the tendency to imitation and play is rarely absent. All young animals are given to play. Indeed, some authors think the play instinct an independent disposition. The feeling of the sublime is a form of the aesthetic sentiment, but is a complex mental power. There is the poesy of painting, of music, and even of religion. Fantasy sees things beautiful or embellishes to make things beautiful, but the reality, the truth, is at its basis. If we could entirely abolish poesy, it is a question whether anything would be left to make life worth Hving. Persons with strong aesthetic sensibility positively abhor the coarse, low, sensual ; they are fond of refinement and style, and enjoy the ideal. If they have small reflective power, they will manifest more refinement than solidity, more rhetoric than logic, more dehcacy than vigorous intellect. Persons with little aesthetic sensibiUty are contented with few elegances in Ufe, look at poetry and fine arts with httle enthusiasm, and prefer plainness to ornament. ALTRUISTIC SENTIMENT Persons with a Uvely imagination are generally very susceptible to impressions, some only to the impressions of objects, others to hving things ; hence are they easily afiected by the happiness and distress observed in others, and if their mental organisation supplies them with no counteracting motives, they may act up to the feelings produced in them, and exhibit kindness, charity, and generosity, thus leading to the difiusion of happiness. They manifest the altruistic sentiment. One of its elements, sympathy, is that susceptibiUty which renders one individual ready to catch the contagion of the emotion of another individual, leading men to grieve at the sorrows and rejoice in the pleasures of their fellow-men. Sympathy is the power of realising to ourselves the pains, pleasures, and emotions that do not concern ourselves at the moment, but are manifested in our presence by some other person. Some men have a remarkable aptitude and disposition to enter into the situation and states of mind of those about them, while others are engrossed exclusively with what concerns only themselves. Sympathy is confounded in all languages with tender feeling, but is nevertheless a distinct phenomenon. Love undoubtedly incUnes us to sympathise with one another ; but we may have sym- pathy for many persons whom we do not love, as may be seen in the lifelong endeavours of Howard to ameliorate the fate of the jail population. Benevolence is a pure-hearted sympathy, without any thought of return or reward. Benevolence consists not only in giving. It is pure benevolence to suppress one's own humours and desires when these would be lacking in kindness or sympathy. The softness and consideration, which are the charm of politeness, are EVOLUTION OF THE INTELLECTUAL CAPACITIES 53 the result of it. Deficiency in it, on the other hand, produces callousness to the misery and sufiEering of others. Even robbers can be benevolent ; many a man steals in order to give away. On the other hand, there are people who are benevo- lent, but only at the expense of others. None are so benevolent as the moderately poor, because they are not too far removed from utter destitution to recollect and realise the misery of want. The rich might have abolished poverty by now. The thousands of millions spent on war would have gone a long way towards it. But the rich man is unable to realise to the full extent what poverty means. The only thing he can and often does realise is the meaning of sickness and death ; and that is why his benevolence is exercised for the benefit of hospitals. The greatest benefactor in this direction is often one who would not help a poor man with a sovereign. Benevolence, when active, gives a warm and glowing feeling of kindness and good-will, a tendency to " rejoice with those that do rejoice, and weep with those that weep." Such a person's sympathies will be prompt and sincere. With absence of selfish disposition, he will be charitable and forgiving, have ready sym- pathies and an open purse. Active benevolence with large social feeling adds liberality to friendship, but with large acquiring instinct, he will be more kind than hberal and give his services rather than money. A benevolent person with con- siderable combativeness will be more severe in word than in deed, except when in jjassion ; and with little religious sense will regard charitable work more highly than reUgious faith. Philanthropy is sympathy with mankind as men and is both a positive and a negative virtue ; it attempts to promote happiness as well as to alleviate misery. MORAL SENSE The peculiar feeling of satisfaction or dissatisfaction which accompanies the reflection on our own conduct or which the conduct of others generates in us, in com- bination with reason, constitutes the moral sense, and this faculty, including both a rational and an emotional element, not only passes judgment on our past actions, but contributes in no small degree to shape our future behaviour. The moral sense took its origin from the desire of mankind to live together. The wish to live in famihes imposed upon man certain obligations and duties which varied according to the wants and habits of each community. Man had to act not solely for his own benefit, but had to take the welfare of his family or community into consideration. The great principle has always been : Do unto others as you would be done by ; or the negative : Do not to others what you would not wish that they should do to you. Moral conduct is essentially social conduct, at all events the higher forms of it, which involve the voluntary control and regulation of the instinctive impulses. The moral sentiment is complex, consisting of sympathy (a community of nature and disposition), the altruistic or benevolent tendency, the sense of justice, the desire of approbation and the fear of disapprobation (fear of pubhc opinion, of law, of God), and contains also some intellectual elements. Take the moral sense, and examine the actions which it sanctions and those which it forbids, and thus analyse, or, as it were, decompose, its nature, and it will be found that the actions which it sanctions are those which may be proved by sober reason to be conducive to the well-being and the progress of the race, and that its prohibitions fall upon the actions which, if freely indulged in, would lead to the degeneration if not extinction of mankind. Thus morality simply includes the rules and regulations by which we may all live together in the most happy manner 54 ANALYSIS OF MAN'S PSYCHICAL NATURE possible. Murder and theft and lying can never be to the interest of society ; although in war, political economy, and diplomacy they are still thought to be so. The selfish tendencies manifest themselves without training and spontaneously, and are therefore more active in the child, even though it have marked latent altruistic sentiments. It has yet to learn self-control before the moral sentiments can manifest themselves. All the moral dispositions require education : a love of justice does not tell us what is just. The practice of morality usually extends only as far as persons think they can perceive some personal advantage or immunity from punishment to be gained by it ; hence it is that those who can extensively foresee future consequences of their acts are more moral than those who are ignorant, not so much because they have better intentions as because they can perceive the future effects more clearly than those whose minds are more occupied by immediate pleasure and personal desires. Ordinary persons are practically compelled to " swim with the stream," because the sanction of their fellow-men is the chief regulator of their conduct. To gain the approbation of one's fellow-men is a factor in morality, for the man possessing love of approbation takes prudent care in avoiding the resentment of his fellows. To secure the general praise, avoid the general blame, and escape the general ridicule, a man imitates the general example, and the pressure of this external force upon his actions will be felt by him as a sense of duty. The exercise of self-restraint to pre- vent injuring others in person, or propert;^, or feeling, constitutes morality ; and the doing of such injurious acts is immorality, and may or may not be crime, according as it is or is not punishable by law. Immorality and crime, then, are disorders of conduct in the sense that they are departures from what the universal consent of mankind admits that conduct ought to be. The mistake is often made of attributing moral transgression entirely to im- pairment of Will, as if man were instinctively moral in tendency and, when he does not follow his moral impulses, simply lacks the will to follow them. This is a serious mistake. There is in all of us a constant conflict between the moral, i.e., the altruistic, sentiments and the self- preserving tendencies. Some are by nature endowed more with the one than the other. The man with the selfish instincts in pre- dominance will exercise his will in that direction ; thus moral obUquity may be the result of powerful volition. Children are relatively strong-willed, yet defective in moral sense and conscience. The will to commit breaches of social ethics may be as strong in one individual as the will not to commit them is in another. Right acting, indeed, may require no effort of self-control whatever. When we say that persons with a relatively weak will are more liable to trans- gressions, we really want to indicate that there is such a lack of balance in the arrangement and degree of the various mental powers that the individual is the play of circumstances and can be easily influenced in one or other direction. The man in whom the altruistic sentiments are stronger than the egoistic propensities will be good by nature ; the man likely to sin is the man in whom the altruistic and selfish tendencies are equally balanced and who is therefore more at the mercy of external circumstances. Then there are men who simply follow their animal inclinations, lacking in their organisations any checking power of social or altruistic feeUng. These are the morally weak-minded. Nearly all moral disease arises from unregulated desire ; every desire exposes a man to the temptation of gratifying it, and animal desires are usually the most imperative. Goodness has to be its own reward and badness its own punishment. The good man is not necessarily happy, nor the bad man miserable. But the good man has inner compensations in the known quaUty of the life he Uves ; he finds salvation in the freedom from worry, pessimism, fear, and unfaith. The only temptation is from within. When there is no evil within, the evil may come from without, but will EVOLUTION OF THE INTELLECTUAL CAPACITIES 55 provoke no response from us and will be to us non-existent. The spiritually-minded is not preserved from shipwreck while the ungodly is drowned, but through his calm- ness of mind he may see his chances of escape. The sentiments of common interests in the primitive family and tribe, and the habitual reprobation of certain acts by individuals as injurious to the family or tribe, in course of time generated a sentiment of right and wrong in regard to such acts ; but the approbation or disapprobation, which may turn our choice, may not be of our fellows, but of ourselves. In fact, man, in the solitude of his own thoughts, is still a social animal, and creates a companion out of himself — a critic to whose praise and blame he is keenly sensitive. When a man does, or refrains from doing, an action which he thinks is right or wrong, he is guided in his conduct by the application of certain rules or principles implanted in his mind, either naturally or by the influence of external circumstances. When this moral judgment becomes so active in its operation as to be instinctive it is called conscience. Whenever a man does anything which he knows would meet with the dis- approbation of his friends he experiences a feeling of uneasiness, a feeling of guilt ; and when he does something which would be applauded by his fellows he has a sense of happiness. This is the basis of the moral sentiment with which the voice of conscience is indissolubly associated. A non-gregarious animal can do what it likes ; it has only itself to consider. We follow the traditions of the herd, but these traditions vary, hence the variety of conscience. The fashions of the herd at the time cause opinions to be held which may be false, but if we depart from the customs and fashions of the herd we are likely to feel uncomfortable and to be regarded as eccentric and to be ostracised. The new generally encounters the opposition of the herd. All men's desires, lusts, and passions, if uncontrolled, lead to evil, and against these conscience bars the way. Conscience is a simple desire to do the right thing without hope of reward, sometimes not even caring for the esteem of others or self- esteem, but acting merely from a natural tendency for righteousness. It is the instinctive application to the actions of social Ufe of certain moral ideas found in the mind, and it therefore depends on experience and education for its peculiar phase of actixdty. Conscience alone is a deceitful guide. Like justice, it is blind. What passes for conscience and moral sense in some individuals is merely " dog conscience," i.e., fear of consequences. Many men act rightly only from fear of punishment ; and no distinction in this respect need be made between the man who fears the punish- ment of his fellow-men and he who fears the punishment which he thinks will be meted out to him in another sphere. The fear of sharp punishment may deter a man from evil-doing ; but it does not make him moral. j Scratch ever so lightly the back of civilised man — remove his inhibitions, as by a blow on the head which obliterates all his higher attributes — and we find the animal nature, i.e., the primary instincts. Most of us are a mixture of good and bad qualities. No man ever merited heaven, no man ever deserved hell. Many men appear virtuous because they lead a life so monotonous that they are outside of temptation and their passions are bound to remain dormant. Many men are wicked because their mental powers stopped short at the development of the moral sentiments. There exist moral imbeciles with the animal instincts and the intellect unimpaired. Such persons are deficient of moral guilt. Only those men and women whose active animal propensities are governed by sound moral sense will, when having committed wrong for once, feel the torture of conscience in the loneliness and darkness of the night, and be afflicted with those terrible dreams which are alleged to shake nightly the guilty soul. Not so the moral imbecile. His conscience is not strong enough to torture him. I repeat, let the admirers of the excellence of the human species reflect why, in all 56 ANALYSIS OF MAN'S PSYCHICAL NATURE ages and in all countries, robberies and murders have been committed ; and why neither education, legislation, nor religion, the prison, hard labour, nor the wheel, has yet been able to extirpate these crimes. In Queen Elizabeth's time, out of every thousand persons born, five were actually hanged, as a matter of recorded statistics, yet it did not eliminate crime. Do criminals rob and murder for the sole pleasure of exposing themselves to punishment, and without any temptation ? Suppose we allow it to be education, and not nature, that produces vicious tendencies, the difficulty still remains the same, because education does not depend upon him who receives it ; and education never would develop either good or evil inclinations were not their germs previously existent in human nature. A conscientious tendency in a combative character gives great moral courage. If combined with self-esteem, the person is inclined to be censorious ; and if in addition there is lack of benevolent feeling, the individual is Ukely to set up himself and his doctrines as the only correct standard of truth. Conscientiousness and cautiousness combined render a man uncertain what his duty is ; he will be fearful of doing wrong, and prefer not to act at all than fail to do right. Then there are persons with few and feeble compunctions of conscience. They will consult expediency rather than duty. If they have love of approbation, they will do right when to do wrong would injure their reputation. If their intellect is good, their conduct will be governed by the dictates of reason. As a rule, the higher mental powers, those which are added latest in the scale of evolution, are the first to deteriorate in anything that affects the brain, whether by poisons, injury, or disease ; hence a change in the moral nature of man is often the first symptom of unsoundness of mind. The patients become abnormally egotistic, or else there is apathy and indifference, or complete ethical insensibility. Only in melancholia ethical sensibility becomes exaggerated, conscientiousness hyperactive. Such patients accuse themselves of having neglected their duty, or they worry about supposed sins committed in their early youth, of which they had not thought until the commencement of their illness. When delusions are added to this state of mind, such persons make all sorts of self -accusations. The moral character also undergoes remarkable transformations in the involution process of old age. There are men who, as they grow old, lose all feelings of affection, take a dislike to their own children, and exercise a headstrong tyranny over those who are dependent upon them ; or they become erotic, vain, ambitious ; or utterly selfish. Others become more indulgent, amiable, generous, and more serene than they used to be, owing to the disappearance of disturbing passions and preoccupa- tions. Thpre are some who lose in virtue and there are others who only lose some faults. RELIGIOUS SENTIMENTS Closely alHed to the aesthetic and ethical feelings are the feeUngs of wonder and awe, aroused by the subhme and vast in nature, the feeling of veneration and reverence awakened by the recognition of an exalted influence and authority, faith and belief aroused by appearances for which the intellect can find no natural causes, and the spiritual feeling arising from appearances which suggest a heavenly power. Faith is a fundamental principle of the mind and is first instilled by parenta authority. Without faith no obedience. Men are not moved by knowledge, but by feeling. It is not knowledge which brings happiness ; it is faith. Hence we cling to the latter, though our reason tells us that we have no evidence for our beUef. Faith wiU make martyrs of those who would be terrorised out of convictions that were voluntarily chosen. Faith is to a great extent involuntary, operating silently and intuitively to supply the imperfections of knowledge. Habitually, but unconsciously, we depend EVOLUTION OF THE INTELLECTUAL CAPACITIES 57 on faith in every perception and every act, in every inquiry after truth, and every expectation of a practical result. It is the admission of certain inferences beyond knowledge ; whereas knowledge is inference from experience. Faith by verification is often transformed into knowledge. Every increase of knowledge supplies a wider and firmer basis of belief. If faith be possessed in very large degree, and not checked by reason, it is apt to produce credulity. True faith must be in alliance with the intellect— that is, it must be a belief in things probable. A morbid eagerness for a cheap and easy solution of the mysteries of existence is not sound faith, but a hindrance to philosophy and true religion. The abuse of faith leads to prejudice, the prejudgment of a problem, arriving at a conclusion without having it submitted to the intellect for examination. Many subjects are decided in this lamentable manner. True, we do not always act upon our prejudgment, but few people can say that they are entirely unaffected by it. "We see this principle of faith most strikingly illustrated in that most extraordinary process called hypnotism. It is not merely due to a suspension of reasoning power, but the process seems to establish a proclivity to believe what is stated by another. The creation of prejudice in the minds of the people by unscrupulous persons has blasted the character of many a man — a whisper believed in is often sufficient for 'this. It will damn the measures of some particular statesman, however wise and necessary they may be. It will confirm without examination, or condemn unheard, any stated policy. In fact, political partisanship rests upon it. The man who has formed an erroneous opinion has himself formed it and knows the grounds on which it rests. If he can be made to see that his reasons are ill- founded, his opinion goes at once. The man with a prejudice, however, has no proper foundation for it. He does not himself quite know why he thinks so, and therefore he sweeps arguments aside, and is of the same opinion still. Midway between deference of love and the deference of fear is the deference of awe. It springs from the consciousness of that which is greater than ourselves, even though there be no tincture of fear. We stand in awe of persons who are totally beyond us in their superiority, vvho exist in a sphere of power and glory, which transcends even our understanding, and thus awe has a religious as well as an aesthetic side. Wonder is generally our first impression, when we come across anything that we do not understand. It aids faith in believing things without examination. Those in whom the feeling of wonder is small cannot believe things without satisfactory evidence, especially if their intellect is developed. The less man's reasoning faculties are active, the greater is the attraction which the marvellous and the miraculous have for him ; and the readier is the credence he gives to them. Man has by nature a disposition to credulity. He loves the marvellous and mysterious. Reverence or veneration appears to be a combination of love and awe ; or love, admiration, and fear. Veneration, in its connection with earthly objects, gratifies itself by deference for superior worth or talent, for ancestry, for titles of honour, and even for inanimate objects which have become associated with these or other great quahties. It is a tendency to look up to and admire superiors in rank and power. Without veneration for authoritj^ the world would be uninhabitable to the lovers of order and justice. Veneration is eminently a conservative force. It constitutes the chief ingredient in the adoration of religious worship. There is no worship without veneration. Religious belief consists of an intellectual element and an emotional feeUng. It bears at the lowest stage the character of fear. That fear first created gods is borne out by the fact that evil beings were worshipped before good ones. Belief in gods and belief in immortaUty are at the lowest stage one, for the gods beUeved in are the spirits of the dead, and those spirits only the object of worship which are thought capable of doing harm. Religious veneration is here simply a recognition 58 ANALYSIS OF MAN'S PSYCHICAL NATURE of power. A higher stage is reached when the extraordinary, inconceivable and wonderful awakens religious feeling ; this acquires then the character of admiration and of reverence, and begins to be of a disinterested nature. Man's reasoned beliefs are not the whole of his spiritual nature, hence he is still a prey to religious emotions. Religion is as old as the human soul, and is the expression of its fundamental needs. Dissatisfied with the world as it is, man seeks to flee from it and attempts to discover another, to construct " a new heaven and a new earth." Whether primitive man was bom with a religious sense, or whether he acquired it at the stage when he became capable of abstract ideas, is an open problem. Certain it is that this sense has become innate in the course of thousands of generations, though like other senses it is weaker in some and stronger in others, and some seem to be bom without it. The tendency to worship is found in different degrees of strength and forms of manifestation in different individual organisations. Just as not all who can handle a pencil are artists, not all who can appreciate the practical results of logic are philosophers, or who can make rhymes are poets, so the spiritual capacity is naturally of varied grades. The religious sentiment may predominate just as an inordinate tendency towards music, poetry, mathematics, or any other engrossing pursuit may predominate, and make the character one-sided. Religion is a revelation of man — an historic and progressive revelation of man's hopes and fears, man's knowledge and character. It is an additional powerful motive to correct living. The religious spirit within fortifies the soul, clears the mind, invigorates the nature, and strengthens the heart. Rehgion keeps people moral, but it is not the religious creed which is the basis of morality. It by no means follows that because a man has strong affinities naturally for worship that he should therefore necessarily have a vigorous moral faculty, or a fuller and clearer sense of right and duty than other men have. He in whom the tendency to worship is strongest has not necessarily the noblest type of mind. It is an absurd supposition to think that because a man has not a natural capacity for intense religious impulse, but only possesses a cool reasoning mind, artistic skill, or fine moral intuitions, he is therefore inferior to the person who is susceptible of rhapsodical fervours, or to the person who is chiefly instrumental in unlocking the wonders of science, and setting forth the multiplying harmonies of the universe, and whose lips only utter the varied wisdom pertaining to visible things and every- day fife. Morahty has suffered many times not a Uttle from its connection with religious creeds. Morality survives when creeds die, having its more secure foundation in the hard-won experience of mankind. Theological doctrines vary amongst man- kind, but the religious sense is in all ahke and leads everywhere to moral rules of conduct. Some rehgion is necessary for moral conduct, but not theological dogma. It is not the fault of rehgion that many people are nowadays more influenced by the fear of their neighbour's censure than the fear of God, but the lack of faith in theological teaching. Religion and theology, as I have pointed out in a previous chapter, are not synonymous. Rehgion is the affair of the affections, theology of the intellect. Rehgion was active long before theology was, and will not cease with the decline of theology. A person may hold definite theological doctrines and yet have no spiritual feeling ; on the other hand, a scientifically enlightened person may yet be deeply religious ; for science is not antagonistic to rehgion, only to theological dogmas. Science tells us only how things happen, not why things happen. Often we judge men not by their religion, but by their rehgious observance. Men have been denounced as infidels and atheists, because they did not subscribe to all the dogmas of a particular creed ; but a man may be highly religious without EVOLUTION OF THE INTELLECTUAL CAPACITIES 59 belonging to any particular Church. Religion is based on feeling, not on reason. Priests have laid down dogmas according to their reason, but the state of knowledge was not then what it is to-day. Feelings are pretty well alike in all of us, but reason requires a stock of information ; hence we vary in our interpretation of religious doctrines, unless we accept them simply on the faith of authority. Science can offer no substitute for the rehgious emotion ; for reUgion is made up of belief alone, not of knowledge. However much the modern intellect trained in strictly scientific pursuits may try to curb the spiritual inclinations, there can be no doubt that the religious sentiment has become an element of our nature. Even the atheist experiences its emotions when circumstances arise which appeal to his feelings rather than to his intellect — that is, when he allows his nature full play. The atheist, as a rule, argues against theological dogmas but not against religion. The two are not synonymous ; just as a man's vision does not depend on his theory of light. Dogmas signify the profession of certain fixed beliefs, but the measure of one's belief in the doctrines of one's creed or Church is not the measure of one's rehgion. The individual is subordinate to the Church in his religious beliefs. The Church stands between him and his God. The influence of religion, which formerly detached so many minds from their immediate cares, is gradually diminishing. The unseen has receded ; the eternal has diminished ; the infinite has dwindled ; the reality of the divine has become less credible ; there is an all-round depreciation of religious values. Our generation is not opposed to religion, it is only too busy looking after its material welfare to concern itself much with it. The average man is apt to conceive of religion and spiritual culture as things which it may be quite laudable to cultivate, if one can spare the time and has the inclination, but which have no vital connection with the real business of life. He neglects his inner life in the pursuit of material things and the over-valuation of all the external improvements which technical science has made possible. Religion for a good many people seems no longer to exist save as an honoured name, which once had a good deal behind, but which to them is a mere remembrance which their piety and imagination strives to embellish still with the colours of reality. For a considerable number of other persons, religion is simply imitation ; it is not inwardly experienced in their feelings or in their beliefs. Such people simply reflect the sphere in which they live. The decay of faith is not due to some deadening of the religious emotion, but to a decay of the beliefs which allow the emotion to assert itself. When people were still ignorant religion gave them a theory of life. To-day the theological dogmas are considered antiquated, people have grown indifierent to them, and, unfortunately, many are indifierent to any rehgious impulse whatsoever. There are still many people who profess some religion, but few men and few nations act up to what they profess. In spite of a very great number of religious systems, there is comparatively little religion upon the earth. There are several reasons for this, among the chief being that thousands of the clergy are teaching dogmas which they themselves do not believe, in a manner that does not carry conviction to others. What is really needed is a teaching that will satisfy the modem trained intellect at the same time that it inspires the spiritual graces ; such a teaching must be authoritative if it is to be efiective, and it can only be delivered by those who are cognisant of the difficulties with which they have to deal, and are genuinely possessed of the behefs that they propagate. By miracles of invention we have secured control over steam and electricity, but we are not yet masters of our souls. The ethical function of reUgion is to strengthen the power of self-control, to afiord a sufficient motive to self-denial and self-restraint, and to inspire self-sacrifice for the sake of others. Most people pray to God to give them what they do not deserve ; but prayers for such subjective quahties as for patience under affliction, for charity, for courage, may indeed be said to assure themselves of being granted, for by placing the mind in an attitude of 6o ANALYSIS OF MAN'S PSYCHICAL NATURE patience, or charity, as the case may be, they fit it for the habitual exercise of these functions. It is in this expectation of elevating our character that we should be altruistic, not in the expectation that the accumulation of good marks will open the doors of heaven to us. A critical analysis of our conduct as in meditation elevates the intellectual and moral faculties above the animal propensities and thus further strengthens the mind in the right direction. Even a prayer for health in a truly devout person may have a beneficial effect through the increase of nervous energy applied to the ailing part, in the same manner as suggestion acts therapeutically on many functional disorders and occasionally improves the condition of diseased organic parts. Where faith and spirituality predominate over the animal tendencies — the spirit over the flesh — there is less possibility of succumbing to the temptations of sin, and certainly Uttle chance of sinning becoming habitual. Many men would never acquire those morbid habits, for which they seek the aid of the physician and hope to be reheved by "hypnotism " or "suggestion," had they more spiritual faith. They are unable to control these habits, the indulgence of which was once a pleasure and is now a curse to them, for lack of just that balancing power which the higher sentiments would give them, and we physicians have to instU into them and render permanent just those upUfting ideas which guide the conduct of all good and honourable men. " Suggestion " treatment produces wonderful results, but were the moral and spiritual faculties more active, there would be less need for it. When the religious sentiments are developed in excess the person is inclined to mysticism ; and when perverted or not guided by the intellect there may be superstition, bigotry, fanaticism, delusions, and a ready belief in supernatural phenomena and mysterious occurrences. The intellect being less highly developed, it is guided by the stronger impulse, and may even be employed to search for arguments to support the credulity. Defect of rehgious conduct is common enough ^\'ithout carrying with it any implication of insanity ; but excess and disorder are occasionally seen, and are more decidedly abnormal. In insanity we often find a devout person beginning to exhibit indifference to things sacred, becoming irreverent, profane, flippant. Others are possessed by religious doubts ; while still others develop excessive religious devotion, as in epileptic insanity, or absurd ideas of a religious and occult nature, as in dementia prcecox, or delusions of a religious character, as in paranoia. Delusions of a religious nature also occur in hysteria and melancholia. SECTION II THE MENTAL FUNCTIONS OF THE BRAIN CHAPTER XXVIII THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES It is generally acknowledged that the brain is the structure through whose medium all mental operations take place. We know that organic life, nutrition, circulation, excretion, secretion, motion, in fact all vital functions, can be carried on without the cortex — the outer rind of the hemispheres — of the brain ; but that the manifesta- tion of the intellectual and moral powers, the affections and propensities of self- preservation, cannot take place without it. Provided that the cortex of the brain be not affected, all the other portions of the system may be diseased, or separately destroyed— even the spinal cord may become affected — without the mental functions being impaired. Of course, if the heart, the medulla oblongata, or some other vital part be injured, death will precede any such experiment. If, on the other hand, the superficial grey matter of the brain becomes depressed, irritated, injured, or destroyed, the mental functions are partially or totally deranged or become wholly extinct. When the compression of the brain is removed, as in the case of an indented skuU, or a tumour, or the extravasated blood or accumulated pus is evacuated, or the cerebral inflammation allayed, consciousness and the power of thought and feeling return. We not only think but feel, rejoice and weep, love and hate, hope and fear, plan and destroy, trust and suspect, all through the agency of the brain cortex. Its cells record all the events, of whatever nature, which transpire within the sphere of existence of the individual, not merely the intellectual knowledge acquired, but hkewise the emotions passed through and the passions indulged in. it Is therefore wrong to employ the word " mental " as meaning " intellect " only ; it should refer to all the powers and attributes of the mind — intellect, feehngs, and primitive desires — character as well as intelUgence. We can only manifest our intellectual aptitudes, moral dispositions, and ten- dencies to self-preservation through the mechanism of the brain with which we happen to be endowed, and according to the sort of experience we have accumu- lated. Hence, though the primitive mental powers and fundamental anatomical parts of the brain of all men are the same, we all vary according to the mental pre- dispositions and brain types we have inherited and the early education we received. Of all the organs in the human body, the brain ranks highest in importance ; yet, as we have seen, until about a century ago it received hardly any attention, and even at the present day the knowledge of its mental functions is still very obscure. It seems that the influence of antiquated metaphysics based on the results of self introspection has not yet worn off entirely. For mind is still regarded by some as i- it consisted ol intellect alone, whereas we all feel and strive, as well as think, with our 62 THE MENTAL FUNCTIONS OF THE BRAIN brains. If it were not so, of what use would be the animal brain, as, for instance, that of the mouse, which has in proportion to the size of its body more brain than man (according to Wagner), and should therefore be more intellectual than any human being ? Another remnant of metaphysical days is the view held by certain physiologists that all knowledge is derived from sensation. Whereas it is not the perfection of the senses which gives intelligence to the brain, but it is the perfection Of tlie brain wiiicii determines tlie employment of the senses. The senses are perfected in childhood long before the structure of the brain is completed. The gradually increasing inteUigence displayed throughout infancy and youth is due to a large extent to the completion of the cerebral organisation ; and talents are sometimes displayed in later years of which there was no suspicion during the process of education. Where the whole or parts of the brain remain arrested in their growth, education and experience are of no avail. The cortex of the brain is the exclusive organ of the primordial psychic activities. I say " psychic activity " and not " mind," for I think it is a mistake to regard mind as an entity. It is too often described as if it laid a clutch, as it were, upon the brain, when it thinks, desires, or wills ; or were to use it as a complex tool or mechanism in thought and feeUng, somewhat as senses and fingers avail themselves of a calculating machine or of a musical instrument. An entity remains always the same ; but if we regard mind as a " force " (see Chapter XXXIX.), we can under- stand that it varies in strength, that it can give energy to a weak part — by the concentration of suggestion or auto-suggestion — and we can understand that it is present in the whole and in every part of the body, owing to the close relation between brain and nervous system, and the latter being ramified throughout the body. We can understand how somatic conditions can influence psychical activity by influencing mind-force, but cannot create or destroy any of the primordial psychical activities, as influences acting directly on the brain cortex can. We can then understand that insanity may be due to toxic conditions in the bodily organs producing a degradation of function, without as yet producing a degradation of structure ; and why functional disturbances may be corrected while structural changes are hopeless. The primary seat of mental disturbance is not always in the brain itselfc The brain, by means of its nerves, is in direct or indirect connection with all the bodily organs. We know that bodily conditions will affect the nutrition of the brain and modify its functions. At one time all looks bright, cheerful, and encouraging ; at another time, not far distant, the same identical prospect looks cheerless, gloomy, and tinted with despair. This change depends upon physical conditions. \Mien there exists a condition of good nutrition of the brain centres we experience a pleasant, agreeable sense of well-being. When the nutrition is imperfect the consequences are a mixture of irritability and bad temper, blended with depression. Hence it is possible that a brain intrinsically sound may show some morbid mental manifestations for the sole reason that the stimulations reaching it from other parts of the body are not normal. If the brain is really normal, such disturbances only arise with difi&culty, or at any rate they pass away on cessation of the cause. Where the disturbances persist, there is always some weakness in the central organs. One of the most necessary conditions for the proper manifestation of mental functions is that the brain should have a regular supply of arterial blood. The stoppage of one of the great arteries leading to this organ, either by compression in the neck, or by emboHsm at some point along its course, at once produces profound disturbances and even complete cessation of consciousness. It has been calculated that, while the weight of the entire encephalon is only about one forty-fifth of that of the body, the supply of blood used up there is not less than about one eighth of the whole supply. This expenditure is indicative of the large amount of work done THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 63 by the intra-cranial organ. It has also been shown that the temperature rises and falls in the whole cerebral area, or at particular circumscribed regions of the cortex, in close connection with the psychical activities. To the man with depressed circulation the world seems sad, thinking requires an effort, movement is painful. To the man with an accelerated circulation the world and his own fate appear in rosy colours, and his capacities and possibihties seem to him infinite. His memory is active, he is continually planning and creating, and constantly on the move. In anaemia of the brain, as every attendant on the insane can observe, it is not only the thoughts that are slow, but there is less response to the affections, and the propensities are inactive. In engorgement of the brain we get hyper-activity, not only of all the intellectual powers, but also the sentiments and emotions, and the passions may be so active that restraint may become neces- sary. The individual manifestation will of course vary according to the natural character of the patient, but in all cases the natural characteristics wUl be more accentuated. This is another proof that the emotions and propensities, as well as the intellect, are dependent for their manifestation on the brain. We know as yet so Uttleof the mental functions of the brain that it is still a problem whether optimism and pessimism are due to peculiarities of the brain or due to bodily conditions. No doubt there are men who by nature are cheerful, hopeful, and enjoy being alive, however squalid their circumstances and mean their occupations ; and there are others who, whatever may be their good fortune, are gloomy, de- pressed, seeing clouds in the brightest sunshine of life. These dispositions are said to be due to superabundance or deficiency of vital energy — but that this is not so, or, at least, net entirely so, is shown by those people who in sickness are still optimists, and, even when told of their approaching death, either refuse to believe it or hope for some miraculous help, or accept their fate stoically. Optimism stimulates the activity of the vital organs ; the pessimistic disposition slows the vital processes, slows the response to impressions from the external world, and disinclines the individual to make new adaptations to its environment. The bodily organs become sluggish and inert, except when temporarily animated by some physical agent or the stimulus of hvely social intercourse. Mental disturbances may also arise from excess or deficiency of the secretions Of certain glands^for example, of the thyroid. Atrophy of the thyroid gland changes a normal child into a stunted and frightful cretinous idiot ; on the other hand, hypertrophy and hyper-secretion of the same gland produces an over-emotional, restless, and unstable nature. The influence of the constitution on the mental activity varies largely according as (i) the vital bodily organs, or (2) the bones and muscles, or (3) the brain and nervous system predominate. The first we can call the nutritive or vital ; the second, the mechanical or motive ; the third, the mental or nervous constitution. The man with the first says / live and I enjoy ; the second says / work and I execute ; and the third I think and I plan. The first manifests geniality, love of ease and domesticity ; the second, industry, energy, self-reliance, force of character and endurance ; the third originates, reflects, and refines, is sensitive and emotional, and attracted by intellectual pursuits. Few people are of such pronounced types ; most men and women are more or less balanced. Still, there are a good many for whom this division holds good. The brain is incontestably the dominant organ of the body, affecting all its tissues, controlhng all its functions, and regulating all its energies. When any other organ is affected by disease it is, after all, merely a part of the man that suffers ; when the cortex of the brain goes wrong in its mechanism it is the man himself that is affected. No instance has been found where an individual has manifested mental power without a brain. A diseased brain produces diseased manifestation. It appears that in some of the lower animals the psychical life is not inseparably 64 THE MENTAL FUNCTIONS OF THE BRAIN bound to the cerebral hemispheres ; still, in the case of the higher mammals, and especially in the case of man, the connection undoubtedly exists. Other things being equal, the greatest amount of mental capacity and vigour (functional power) is allied with the largest quantum of cerebral substance. All observa- tion as regards men and animals proves that the energy of any nervous centre always bears a direct proportion to its bulk, whether absolute or relative. Every organ of our body increases in size in proportion as it is exercised within the hmits of its physiological capacity, and this holds good as to the brain as well. With increased mental work — emotional as well as intellectual — the brain will show an increased growth. That is why in the insane the cranial capacity is greater than in the sane. (Measurements made by Amadei, Meynert, Obernier, Sommer, and Peli.) The entire brain may be too small. Heads measuring eleven to thirteen inches in circumference and with a longitudinal diameter — from glabella (root of the nose) to occipital spine — of eight to nine inches, belong to the lowest class of idiots, where the intellectual manifestations are nil. Heads with a circumference from fourteen to seventeen inches and a longitudinal measurement from eleven to twelve inches show glimpses of feeling and random intellectual perceptions, but without any power of attention or fixity of ideas. Heads of so small a size are accompanied by a greater or less degree of stupidity or fatuity, vague sentiments, indeterminate and transitory affections and passions, an irregular train of ideas, speech consisting of broken phrases, and blind and irregular instincts. Heads of eighteen to nineteen inches in circumference are small, yet if well-bal- anced are not incompatible with the regular exercise of the intellect, which, however, is deficient in intensity. They indicate a pitiful mediocrity, a slavish spirit of imita- tion, credulity, superstition, that species of sensibihty which by a trifle is raised to the height of joy, or plunged in an abyss of tears, a very fallible judgment, an ex- treme difficulty in discerning the relation of caiuse and effect, a want of self-control, and frequently, which is a happy circumstance, but few desires. With this degree of development, however, there may exist some marked mental aptitudes — such as a remarkable memory for figures, dates, music, etc., because some cerebral parts may be more fully developed. As a rule, when the brain is too small, it is not dwarfed equally in all its parts, but is specially so in the pre-frontal regions — in those parts which manifest the pecuUar human faculties and sentiments — ^while the hinder and lower parts of the brain — those which are the seats of the appetites and propensities — are far less affected ; hence also the peculiarly animal look. The average circumference of the head should be twenty-two inches. The measurement from the root of the nose to the occipital protuberance should be on the average fourteen inches. The brains of men who have distinguished themselves by their great talents are often larger, and those of feeble intellectual power smaller. JOHN VENN and FRANCIS GALTON read a paper to the Anthropological Society, April 24th, 1888, on Head Growth in Students at the University of Cambridge, containing the following conclusions 1 . Although it is pretty well ascertained that in the masses of the population the brain ceases to grow after the age of nineteen, or even earlier, it is by no means so with University students. 2. That men who obtain high honours have considerably larger brains than others at the age of nineteen. 3. That they have larger brains than others, but not to the same extent, at the age of twent3^-five ; in fact, their predominance is by that time diminished to one- half of what it was. 4. Consequently "high honour" men are presumably, as a class, both more Male. Female Cubic centimetres. Cubic centimetres 400 360 540 510 900 850 1080 lOIO 1360 1250 1450 1300 THE BRAIN: THE ORGAN OF THE PSYCHIC ACTIVITIES 65 precocious and more gifted throughout than others. We must therefore look upon eminent University success as a fortunate combination of these two helpful conditions. The following figures of HERMANN WELCKER (1822-1897), of Halle, exhibit the cranial capacity in man at different ages, and consequently the progressive volume of his brain : New-bom infant At two months At one year At three years At ten years From twenty to sixty years WEISBACH obtained the following weights of the brains of males between the ages of ten to ninety years, showing the increase in the weight of the brain up to middle age, and the decline of its mass in senihty : 10-19 years of age, 1270 grammes 20-29 ,. 1355 30-59 „ 1375 60-90 ,, 1349 The average cubic capacity of the slcuil, according to MANOUVRIER, is 1560 cubic centimetres in ordinary men and 1665 c.c. in eminent men ; and, according to BORDIER, 1540 c.c. in murderers. The following are the sicull capacities of some well-known men : Age 39. . . .Skobelefi, general 1457 c.c. ,, 43. • . .Gambetta, statesman 1294 ,, „ 51 . . . .Donizetti, musician 1391 ,, (died of G.P.I.) ,, 53 . . . .Thackeray, author 1644 ,, ,, 54. • . .Descartes, philosopher 1700 ,, „ 56. . . .Broca, anthropologist 1485 .. ,; 56. .. .Dante, poet I493 ,, ., 57. . . .Spurzheim, phrenologist I559 ,. ,, 59. . . .Dupuytren, surgeon 1436 ,, „ 62 . . . .Bertillon, anthropologist 1398 ,, ,, 63 . . . .Cuvier, naturalist 1830 ,, ,, 64. . . . Abercrombie, physician 1785 ,, , 66. . . . Agassiz, naturalist 1512 „ ,, 70. . . .Liebig, chemist 1352 ,, ,, 70 ... . Gall, anatomist 1692 ,, „ 70. . . .Petrarca, poet 1602 ,, ,, 74 .... La Fontaine, author 1950 „ „ 75 ... . Grote, historian 1410 ,, ,, 78. . . .Gauss, mathematician 1492 ,, 78. . . .Tiedemann, anatomist 1254 ,, ,, 80 ... . Scarpa, surgeon I455 ., ~ ,, 82 . . . . Volta, physicist 1745 .. The orang and chimpanzee have cranial capacities of 26 and 27^ cubic inches respectively ; while for normal man, the lowest cranial capacity is 55 cubic inches. As to the weight, the gorilla's brain weighs 20 ounces, and those of the other anthropoids range from 12 to 16 ounces. But the average weight of the civilised male Vol. ii.] F 66 THE MENTAL FUNCTIONS OF THE BRAIN brain is 49 ounces, of the female 44 ounces, while a weight of from 32 to 37 ounces is the minimum compatible with ordinary human intelligence, though idiot brains may sink as low as 10 ounces. The factor must not be overlooked that man's body- weight is about half the weight of the gorilla's body ; which makes the difference in brain-weights more striking. The following are the brain-weights of some well-icnown men : Age 39. . . .SkobeleflE 51-5 oz. 44 . . . . Gambetta 39 ,, 46. . . .Schiller 63 ,, 53. .. .Thackeray 58-5 ,, 56 ... . Spurzheim 55 , , 56.... Dante 51-3 ,, 58. . . .Dupuytren 50-7 ,, 59. . . .Napoleon 57 63. . . .Cuvier 645 ,, 64. . . . Abercrombie 629 ,, 67 ... , Chalmers 53 ,, 70 .... Daniel Webster 53-5 ,, 70. . . .Gall 4225 ,, 75 Grote 4975 „ 78. . . .Gauss 526 ,, 80 . . . . Tiedemann .442 ,, 80. . . .Grant 45-5 ,, Of more recent brain-weights taken, the lowest recorded was that of Ignaz von Dollinger, the celebrated Catholic theologian, which weighed 1207 grammes, and the heaviest was that of Turgenieff, the Russian novelist, which was 2012 grammes. How unreliable — without the fullest details — these brain-weights are, is shown by the careful weight taken of the brain of HELMHOLTZ, distinguished for his wonderful researches in optics. (" Zeitschrift fiir Psychiatrie," 1899). The weight of his brain, including the blood coagulum, was 1700 grammes. This being removed, the brain weighed 1540 ; but so much blood remained that it was estimated that 100-120 grammes should be deducted. This would reduce the brain-weight to 1420-1440 grammes. Helmholtz had therefore a brain not much above the average weight ; but how do we know that in the cases of those very heavy brain-weights recorded allowance was made for the quantity of blood, as was made in the case of Helmholtz ? The brain of CUVIER remained for a long time the heaviest brain recorded of distinguished men. The weight was stated by WAGNER as 1861 grammes, but this BROCA corrected to 1829-96 grammes. Even thus reduced it exceeds the limits of the normal human brain by nearly one-third. The frontal lobes were abnormally large. He was an all-round genius. To SPITZKA, an eminent American neurologist, the explanation of Cuvier's heavy brain was very simple : it represented not intellect, but healed-up hydrocephalus. Celebrities with large heads will not feel flattered by this explanation. Science is rarely complimentary, but this is well-nigh libellous. Lord BYRON died in Greece in 1824, and English papers reported his brain- weight as six medicinal pounds, a round figure which renders it suspect of being inaccurate. In any case it was probably a Neapolitan or Venetian weight, the former 1924 gr., the latter 1807 gr. ; and it was stated that Byron's brain was in a hyperaemic condition, so that probably no allowance was made for the blood which the brain contained. The use of different standards of weights and measures, and of diverse materials for determining the capacity of the skull in different countries, greatly comphcates the researches of the craniologist. CROIVIWELL'S brain is estimated at 78.8 oz., but must also be exaggerated, considering the size of the head in his portraits. Sir WALTER SCOTT'S portraits show an astoundingly large head, especially in THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 67 height. The cranial arch from ear to ear measured from the mastoid process was 19 inches, whereas the average is only I4'6. The circumference of his head was 23' I inches, the longitudinal diameter 9 inches, and the parietal 64 inches. Yet in the report of the post-mortem examination of Scott, the physicians stated that " the brain was not large." The peculiar shape of his skull was attributed to his lameness dating from his infancy — another healed-up hydrocephalus. But if, as his physician supposed, " the sagittal suture closed prematurely," his skull could never have achieved the enormous height. On the discovery of DANTE'S remains at Ravenna in 1865, the skull was pro- nounced to be ample, and exquisite in form. But its actual cubical capacity and estimated brain-weight falls considerably below those of the heaviest brain-weights of distinguished men. Size of brain is of course only a measure, and not the measure ; for a small braia but of superiority in texture, complexity of convolutions, and depth of sulci may equal a large one ; still, too much importance need not be attached to the frequent statement that the brain was rich in convolutions, for we know of no average in this respect. It is also a sad fact that many men, for lack of opportunity, are not in a position to use all the brain material at their disposal. I have all my Ufe observed living heads of all sorts and collected portraits of distinguished men of the past ; and I can confidently assert that no man with a small head is really great ; none such ever originated or led revolutions in science, letters, religion, or government ; or in any way stamped an image of himself on his country or age. Such an event would be as extraordinary and unnatural as the existence of gigantic muscular strength in the person of a dwarf. All history testifies to this. From Pericles, Aristotle, and Alexander, passing through the Caesars, Ciceros, and Bacons, down to Napoleon, Fox, Bismarck, and Richard Wagner, every great conqueror, statesman, writer, or pioneer in any department has had a large head, with predominating frontal region. Too much reliance is still placed on the now very old researches on the weights of brains made by RUDOLPH WAGNER (1805-1864), of Gottingen. He furnished by far the largest number known, and not many have been added since. He measured and weighed so many brains of renowned men, that a weight below the normal, i.e., average, gave rise to the suspicion that the man was after all not so clever as was thought during his lifetime. This alarmed some of his renowned contemporaries so much, that they thereupon had a clause inserted in their wills, forbidding a post- mortem examination of their brains. Few brain-weights are taken nowadays, and the old results are almost worthless ; for the number of weights taken were far too small and greatly wanting in details. Moreover, there is great variation in the size of the inch. For example, Gall means French inches, which are about one-sLxteenth longer than the EngUsh. What we require is the weight of thousands of brains — of healthy, not of insane and diseased brains — each brain being weighed as a whole, and each part — frontal, parietal, temporal and occipital — according to an agreed anatomical division separately. It is of little value to know the weight of the brain of an eminent man without knowing the weights of the different parts. For, as is well known, the frontal lobes ma\r be highly developed and the occipital lobes may be deficient ; in another brain of exactly the same weight the parietal lobes may be massive and the temporal lobes very small. That the entire weight is misleading is shown in the case of the late Professor L. BISCHOFF ( 1 807-1 882), of Munich, who was one of the anatomists of Europe to defend the hypothesis of the mental inferiority of women against men, chiefly on the ground of the fact that he claimed to have observed that the average weight of a man's brain is 1350 grammes, but of a woman's only 1250. After his death the 68 THE MENTAL FUNCTIONS OF THE BRAIN post-mortem examination elicited the interesting fact that his own brain weighed only 1245 grammes. The average weight of the brain of a European male, as has been already men- tioned, is forty-nine ounces, and of the female forty-four ounces. This difierence between the sexes is less marked in savage than in civiUsed races, and may be explained on the ground that in the lower races there is less difference in the educa- tion of the two sexes and the work done by them. We want new measurements of female brains. It would be interesting to observe, for example, what is the differ- ence, if any, between the brain of a distinguished male and a distinguished female doctor of medicine. It must also be pointed out that the ordinary European averages of brain-weight are founded on the working classes, and generally not on the most successful members even of those classes. It is therefore not surprising that notable men should exceed the general average in brain-weight. That the whole brain does not subserve only the intellectual functions is shown by the occurrence of emotional insanity and of certain systematised insanities and monomanias, in which the perception, memory and judgment remain unaffected. These affections can only be explained by disease of one part of the brain causing derangement of some of the intellectual capacities, while disease in another part may not disturb the intellect, but derange the moral powers or propensities. If the whole brain did subserve the intellectual functions, we should be unable to explain the idiot, whose brain is arrested in growth. He should be incapable of manifesting any emotion ; whereas, on the contrary, his emotions are manifested all the more strongly for lack of the inhibitory control of reason. The intellect can only ap- preciate facts ; it does not supply motives. We act from affection, and think in order to act. The world is governed not by thought but by emotion, and in judging a man we have to ask what are the motives that habitually determine his conduct whatever may be the means his intellect devises for the attainment of his ends. Size of head indicates mental power but does not tell us whether that power lies in extent of intellect, in strength of moral feeling, or in power of passion or affection. We repeat again that the cortex of the brain records aU the events, of whatever nature, which transpire within the sphere of existence of the individual, not merely as concerns the intellectual knowledge acquired, but hkewise the emotions passed through and the passions indulged in. Most men utterly disregard this distinction. They confound intellectual power, moral feeling, and brute propensity, and treat the brain as if it consisted only of one lobe with only one function, namely, the manifestation of intellect. Thus TIEDEMANN inferred, and Sir WILLIAM HAMILTON concurred with him, that because the negro brain is equal in weight to the European, therefore the negro is also his equal in intellectual power. Comparisons are frequently made between European and savage brains, but such comparisons to be of value should be made between savage brains and those of unsMlled workmen or vagrants ; for the educated man has the advantage of the accumulated knowledge and civiUsation in general. After all, it is very doubtful whether the great mass of men in our day exercise so much more comphcated mental functions than the savages. Those who invent nothing, improve nothing, and, confined to their trade, swim with the great stream of imitators, understand only a small part of the manifold machinery of modem civihsation. The locomotive and the telegraph, the prediction of ecUpses in the almanac, and the existence of great Ubraries with hundreds of thousands of books are taken for granted by them, and do not trouble them any farther. Whether now, with the rigid division of labour running ever into higher social positions, the functions of such a passive member of modern society are much higher than those of the native of Africa or Austraha may be very much doubted, especially as the latter are undervalued. THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 69 On the other hand, there is a probabiUty that many of the present tribes of savages are, in point of civilisation, in a more degenerate condition than their fore- fathers, who acquired originally higher mental quahties under natural selection. And, if such be the case, we naturally expect to find some stray races with inherited brains of greater capacity than their needs, in more degenerate circumstances, may require. An exact equivalent to this may be seen in the feeble intellectuaUty of many of the peasants and lower classes among the civilised nations of modem times. The capacity is there, but latent. Hence it happens not unfrequently that a youth born of such parents, if educated, becomes a distinguished citizen. Similar remarks are apphcable to the skulls of prehistoric races, as it would appear that evolution had done the major part of its work in brain development long before the days of neolithic civilisation. Some of the skulls of fossil men are of large size, but chiefly in the posterior region. It would seem that the growth of the frontal region of the brain diminished the posterior development. Until localisa- tion of brain functions makes greater progress it is futile to speculate, to any great extent, on the relative sizes of skulls of different races, either in present or pre- historic times. Owing to the ignorance of the fact that the primary emotions and propensities are as much related to the brain as the intellect, weights and measurements are taken to this day — as we have seen — of the entire brain and deductions drawn as to the intellectual capacity of the individual. The evidence of comparative anatomy is entirely overlooked, that we have some parts of the brain in common with animals, to administer to our animal wants, and that only those parts which are charac- teristically human can have any relation to the higher intellectual processes and moral powers for which man is distinguished. Prof. KARL PEARSON, in a paper read before the Royal Society on January 23rd, 1902, endeavoured to show that there is no correlation of intellectual abihty with the size of the entire head. This is obvious, for the purely intellectual functions, as we shall produce evidence presently, are confined to the frontal, or rather the pre-frontal, region of the cortex, which is at best one-third of the entire mass of the brain. Prof. C. S. SHERRINGTON {Lecture on Physiology for Teachers, London, 1901) is therefore also quite correct in his observation that the brain may be wide or narrow, deep or flattened, the shape of the entire mass will not give any clue to the intellectual endowment of its former possessor. No matter whether the head be large or small, and the brain heavy or light, the entire mass will give no clue to the intellectual ability or moral character of the individual. We must compare the relative development of different regions in the same brain to come to a conclusion. Circumference alone, as a measure of the skull and its contents, is inadequate ; for the brain may grow in certain regions without affecting the circumferential measurement. Thus I have three female adult skulls in my collection, each one has the circumference of 524 millimetres, i.e., 20-6 inches, but the cubic capacity of • No. I is 1390 cubic centimetres No. 2 ,, 1550 No. 3 ,, 1420 ,, ,, which shows a difference between skull No. i and skull No. 2 of 160 cubic centi- metres, or 11-5 per cent. This shows that we want to weigh each lobe separately, and even definite segments of each lobe. A high development of a particular region as compared to the rest of the brain is generally associated with special mental powers of which the region in question is the essential basis ; just as in animals that possess an extraordinary sense of smell there is a relatively large development of the olfactory bulbs. Men are bom with intellects or understandings which differ materially from each 70 THE MENTAL FUNCTIONS OF THE BRAIN other, so that there are particular kinds of understandings as there are of instincts among the animals, and we must conclude that each kind of understanding has a particular instrument for its manifestation. The difference in the mental powers of members of the same family arises wholly from the various degrees of development in the different cerebral parts. All normal human brains exhibit the same parts and have the same primary mental powers, but vary in the relative development of the different convolutions, principal and accessory. This relation is infinitely varied, hence the great variety in the character of men and the different degrees of development of the primitive mental powers in the same individual. Each individual comes into the world with a varying potentiality of development, and with an innate tendency for that development to take place more readily along certain lines than along others. There is not the slightest doubt that the innate developmental capacity of the brain cells varies greatly in different individuals. In some the potentiahty is very great, in others it is comparatively small. This seems to be particularly the case with certain regions of the brain, and in con- sequence we have striking differences in family aptitudes. There are some families the members of which evince a marked predilection for intellectual pursuits ; there are others of which the members are bom soldiers or travellers, and there are others with a special head for mechanical work of some kind or other, and with but little proclivity for book study. These differences are clearly inherited. Of course, environment exerts a considerable influence, but environment cannot supply faculty of which the rudiment is non-existent, nor can it modify to any great extent the course of inherited tendencies. These things it cannot do, but it can certainly afford or withhold the opportunity for the development of those tendencies. The environment can, in short, encourage or discourage mental evolution. Quality of brain does not account for these differences ; for, as a rule, all the parts of the same brain have the same quality. But if we compare two brains, we must recollect that their size may be equal, and that nevertheless the one, from possessing the finer texture and its owner having a more vigorous bodily constitution, may be active and energetic, while the other, from being inferior in quality, or its owner having a difierent kind of temperament or feebler constitution, is naturally inert. Another explanation put forward is that the differences obtaining in the weight of brains are due wholly to differences in the bulk of the body. This argument has been disposed of by Sir WILLIAM TURNER (i 832-1916), who said : " The human brain, in all probability, attains its full size and weight at or about the age of thirty, whilst the body not only increases in weight after this period, but in one and the same individual may vary considerably in weight at different stages of adult life, without any corresponding fluctuations taking place in the weight of the brain." Small heads are rare with tall men, while large heads are very common with Uttle men. When large heads show small intellectual capacity, we must look for power in the emotions and propensities. Some big-headed men are little more than big animals ; they may manifest considerable mental power, particularly in the direc- tions of the feelings and passions, though little intellectual. On the other hand, there are multitudes of comparatively small-headed men who display an almost unquenchable thirst for knowledge, an aptitude to acquire it, and a disposition to make right use of it ; such small heads consist almost entirely of frontal brain — the region which we shall prove to be connected with intellectual functions. Many men possess not general intelhgence, but a special intelligence, which THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 71 makes them successful ; accordingly they may have small brains, well developed only in one or a group of centres, and not heads large all round. Specialists' brains are often small — too small for their possessors' judgments to be trustworthy except in their narrow speciality, and often not even in that. EDINGER, in his " Anatomy of the Nervous System," showed that special ability, as in certain great men, com- manders, business men, etc., is not due so much to big brains as to the development of special parts. Again, the logical faculty of reasoning may be highly developed in a small brain and its possessor be a very great man. This type of man is often unable to take any special part in the orchestration of civilisation, but as leaders to direct and harmonise the efforts of other specialists they may be superb. We all know plodding successful specialists of extremely limited mental horizon, scientific investigators too narrow to interpret their own results and discoveries, philosophers who have no idea of number, mathematicians who are unable to talk, statesmen without business sense, men ignorant of the existence of Shakespeare yet possessed of executive ability enabUng them to manage vast affairs, while men noted in other respects may be so devoid of executive ability as to bungle everything they attempt to manage. Practically we have every possible grade between degenerate imbeciles like " Blind Tom," with but one developed faculty, and those having many faculties developed, the equally impracticable " Admirable Crichtons." Mind and consciousness are bound up with a brain in us ; but just as in the lower creatures there is digestion without a stomach, so there is consciousness without a brain. Only, in proportion as the organism becomes more perfect, a division of labour is brought about : special organs are destined to diverse functions instead of the whole mass doing all. But the function was previously performed in the undifferentiated organism ; it was performed all over it, though with less precision. It is astonishing that there should still be men existing who pin their faith to the behef that the brain acts always as a whole whatever the mental function — that the same structure acts in anger, fear, aesthetic emotion, love, scientific observation and metaphysical thought. Those who hold that belief might as well say that the same aggregate of brain-cells is engaged in the function of seeing, hearing, and smelling ; but they do not go so far because they know it is not true. The olfactory lobes, for one, are so distinct that they must be acknowledged. But why, if we admit different regions for the various senses, should we not admit that the primordial activities of the soul should have separate instruments in the brain, though so closely interwoven by a network of fibres that the action of one will set the others into vibration ? The discovery of anatomically distinct areas in the brain by BROD- MANN and ELLIOT SMITH would point to such an interpretation. There is nothing unreasonable in the supposition that an indivisible soul may have the power of seeing, hearing, reflecting, and manifesting various primitive feelings through the medium of a complex brain. Those who do not admit the plurality of centres are thrown back on assuming a compound soul or mind acting through a simple brain ; or on assuming that the soul, with its emotions, passions, judgment, and the senses, acts independently of the brain, and is divisible though immaterial. Some metaphysicians get out of their difficulty by explaining that the various mental powers are only particular modes of action : " The mind itself existing in certain states " (Dr. Thomas Brown). That is, a constantly changing mind — the mind in a state of anger, love, fear, observation, reflection, imagination, etc., dancing out of one state into another. Is such an idea consistent with our experience ? Others make a great deal of the consciousness of personal identity, but ignore the cases of dissociation of personality. In a state of health man is conscious of his own identity ; but when labouring under disease, consciousness is frequently disturbed or even lost. If the psychical activities are independent of definite and separate 72 THE MENTAL FUNCTIONS OF THE BRAIN instruments we cannot understand insanity. We cannot admit a mind disease, and still less that portions of our psyche should be diseased while the remainder remains healthy. But insanity can be readily understood if we admit that certain areeis of the brain, through which mind acts, are in a disordered or diseased condition, while the remainder is still normal. There is no mental unity even in tlie ordinary healtliy conditions. There is not a man in the world whose memory is equally good on every subject and the same at all times. How can a spiritual unity be strong on one point and weak on another ? Just imagine a spirit becoming imbecile, weak, tired, and exhausted ! May we not conclude, then, that each mental manifestation takes place through a special and appropriate organ, and that the brain consequently consists of a congeries of centres for the manifestation of the various psychical activities, or rudiments of those activities ? By assuming that the mental powers of perception, deduction and induction require separate mechanisms of brain-cells, I do not destroy the psychical nature of the soul ; on the contrary, I prove that the products of perception and thought are unlimited and purely spiritual. No one will assert that if I recall in my mind a mountain scene, or create a vision of a machine, that these things are physical. They have no actual existence ; but as I have an eye for seeing and an ear for hearing, so I must have some mechanism for the elementary psychical processes, without which the perception and creation of these things is impossible. Even to conceive the Power of an Almighty and to be able to render devotion to Him I must have some brain elements to get into that condition ; for where these elements are lacking, as in arrested brain growth of idiocy, or where they are destroyed through brain injury, that power may never exist or be lost, and the individual be reduced to an animal state. Long-continued mental application does not fatigue all the mental powers in an equal degree. Rest can be obtained by a change of object. This would be an impossibility if the whole brain were engaged in each mental exertion. Take, furthermore, the phenomena of dreaming. During that state several of the mental faculties, moral, affective, as well as intellectual, are evidently active, while the remainder continue dormant. The natural result of such an arrangement is that we sometimes imagine ourselves engaged in actions which, in our waking moments, we should never have undertaken, because in the latter state our decision would have been influenced by feelings and faculties that in our dream-moments were asleep. It has already been pointed out that in partial idiocy the individual is exceedingly deficient in most of the intellectual powers, and yet may possess a few of them in considerable vigour. Thus an idiot may have a talent for imitation, for drawing, or for music, and be incapable of comprehending a single abstract idea ; or he may show a hoarding inclination, a destructive tendency, or some special instinct in high activity, and yet manifest no other power to any perceptible extent. Were the brain a single organ, then the innate dispositions of each man would be similar. But if there be special aggregates of brain-cells appropriated to different mental powers, then does every modification of intellect and character depend in its elements on a different degree of development attained by these particular parts of the brain, and their varjring degree of activity. There are no two brains ahke in their configuration, nor are the mental dispositions of any two individuals found exactly to correspond. Moreover, the existence of such evidence as that of injuries of tlie tiead affecting, not unfrequently, one or more of the mental powers, while others remain perfectly sound, has appeared to not a few physiologists to render the supposition far from unreasonable that the different portions of the cerebral hemispheres have different functions allotted to them. A large number of cases have been placed on record THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 73 by independent observers, in which some special mental quality or primary feeUng, deranged owing to circumscribed lesion of the brain, has returned to normal activity when the source of irritation has been removed (see Chapters XXIX. -XXXII.). True, now and then we hear that destruction of the grey matter of the brain may occur without any mental change in the patient. But such statements are made by men who have no method in their observation of intellectual changes, and who disregard entirely the alterations in the feelings and emotions of the patient, behev- ing them to be independent of the activities of the brain. Just as the brains of animals differ in accordance with the strength of a particular sense which is peculiar to them — one with a superior smell having large olfactory lobes — so it is not unreasonable to assume that animal brains differ in accordance with the special instincts which tNy manifest ; and, indeed, if we compare the brains of the different species we see essential differences in the form, size, and shape of their brains, and the form and number of their convolutions. Even the individuals of each species, notably of domestic animals, show often essential differences in abilities and dispositions ; for instance, not every breed of dogs could be made into sporting dogs, consequently some essential element in their brain must also vary. We make distinctions also between the skulls of different races, and of different nationalities, and the brains differ also. But, if that is the case, the different regions of the brain must vary in their function. Vision may be in a morbid condition and hearing sound ; or hearing may be disordered and vision sound. Of the other external senses the same is true. They are so independent of each other that either of them may be sound or unsound singly. They have their real seat in different portions of the brain. Vision is not seated in the eye, hearing in the ear, taste in the tongue, smelling in the nostrils, nor touch in the fingers, neither are they seated in the nerves of those organs. The eye, ear, tongue, nose, and fingers are but the externals of the senses, and the functions of these organs are as different as the functions of the nerves they receive, for each organ must be in harmony with its own nerves. This fact alone proves the brain to be a compound viscus. In confirmation of the view here taken, it is well known that blindness, deafness, and an extinction of the other external senses, often depend not on any diseased condition of the external or intermediate apparatus, but on a morbid affection of the brain. When we direct our attention to the lower order of animals, we perceive an accurate correspondence between their brains and mentality. When we find the brain with few convolutions, the animal has few faculties. As we ascend through the higher grades of animals, brain matter and mentahty increase in complexity ahke, until we rise to man, who has the most complex brain, as well as the most complete mental manifestation. This is well known to comparative anatomists and to all naturalists. The human brain contains many convolutions not found in the brain of any other animal ; and human mentahty consists of several powers exclusively its own, the supernumerary convolutions and the supernumerary faculties corresponding. Moreover, different parts of the brain are not developed simultaneously ; but those whose functions are earher called into action have their fibres earher developed. Similarly, the various mental powers appear, some at an earher, some at a later, period. Further, in the same individual, certain propensities, sentiments, and intellectual faculties are manifested with great energy, while others scarcely appear. One may excel in verbal memory, and be incapable of combining two philosophical ideas ; another may be a great painter, and a bad musician, or a miserable poet ; and a third a great poet, but a bad general. Everyone has pecuhar gifts. Hence the same mass of brain cannot preside over dissimilar functions. It is evident, therefore, that the brain must have different centres to account for the great variety in the natural capacities and emotional dispositions. 74 THE MENTAL FUNCTIONS OF THE BRAIN How can a capacity, say, for music, or a disposition to excessive irascibility, be inherited if these are purely psychical tendencies independent of any material organisation for their elements ? But we can explain hereditary mental dispositions by assuming the inherited instrument to be perfect or imperfect. If there were no special centres, how could the transmission of peculiarities of character from parent to child be explained ? Peculiarities of character are no more than modes of faculties, and they could not be transmitted unless we had also a peculiarity of structure in the organ. The mental qualities of the parent may be transmitted to the offspring, either immediate or remote, in an identical or an allied form. Every fundamental attribute of the parent tends to be inherited by the offspring. This is the first and most fundamental law of heredity. But how can mental characteristics be inherited unless there is some physical characteristic corresponding with it ? Those who deny the possibility of different nerve-cells having different functions must, therefore, first explain the heredity of mental characteristics. It has been said that the exceptional talents and characteristics of some men are due to accidental causes ; as, for instance, Demosthenes is said to have become eloquent because he was attracted by the eloquence of Callisthenes. But many heard Calhsthenes who did not become eloquent ; and Demosthenes differed from them by a predisposition to oratory sufficiently strong to make him take the trouble to acquire the necessary skill. All that external impressions can do is to give an impulse to talents which have not been exercised before ; the disposition for such activity must already exist. We must bear in mind that the same opportunity is offered to a great many men, whilst only one is inspired. As FRANCIS GALTON has pointed out, education and surrounding circumstances are only powerful on those men whose innate dispositions are neither too feeble nor too energetic. Even the men of mediocrity have their individual character. There is something in every man which resists all educationary efiorts, as every teacher will know. Last, but not least, we have the observations of numerous investigators showing that certain regions of the cerebrum are distinguished from other regions by broad differences in structure. Not only does the structure in different convolutions assume to a greater or less extent a variety of modifications, but even different parts of the same convolution may vary with regard either to the arrangement or the relative size of their cells. These structural differences must be correlated with some difference of function. The group of cells whose function is purely intellectual cannot possibly have the same construction as a group of cells whose function is purely emotional. The two may be united by association fibres, so that one may rouse the other, but the function of each group of cells must be distinct. This conception of centres would alter none of our known psychological facts. For, as we have already explained, that although we may for the present, not knowing better, localise complex mental functions, it is really only the element of each function that can have a separate centre or instrument — only every primary process of intellect, feeling, or impulse. Let me repeat, that just as we require an eye to see, but cannot tell what the eye will see, so we cannot tell what use the person endowed with the colour sense, or a sense of tone, or his apparatus for anger, love, or fear, will make. Just as sight and hearing are roused spontaneously on stimula- tion of the eyes or ears and their brain centres, so are the brain centres for the primary emotions roused on the requisite stimulus, to a different degree according to the force of the stimulus and the perfection of the particular centre. Science can only say : You cannot have a primary capacity, emotion, or propensity without the agency of certain brain-cells — which are live cells, and not a material apparatus, it is to be remembered — ^just as little as you can have music without musical instru- ments. The fact that instruments are necessary for music does not alter anything in the psychology of music ; nor is anything altered by the assertion that you THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 75 cannot feel angry without a certain group of cells in the cortex being set into activity. Admitting this theory, we can understand why a nervous discharge — as takes place, for instance, when the emotion of fear is aroused — being connected always with a given group of brain-cells, subsequent discharges take place along the same routes and become easier the oftener they are repeated. The more frequently a person allows himself to be frightened, the more timid he will become, for the nervous action becomes facilitated, and it will be more difficult for him to resist it. We may commence by steahng a pin, we may learn to steal a sovereign, and end by being unable altogether to resist tliieving. The brain centres do not contain ideas, but they possess the mechanism to compose ideas. Therefore we cannot say that a person with a certain brain formation is, for example, musical, but only that he has certain brain areas for the appreciation of tone, time, and harmony so perfectly developed that the instruments are there which, given favourable circumstances, would make him easily develop musical ability. The sensory centres are not the centres for intellectual activity, for knowledge does not depend on sensation alone. What sensation does is to rouse the mechanism of the brain centres for the primordial dispositions to activity, according to their relative development and associative arrangement. That is how the sight of, for example, a wood strikes the poet and timber merchant differently, and the hearing of the same sentence evokes different response in different individuals. These primary centres are for unconscious mental dispositions of ancestral inheritance (as we have already pointed out in Chapter XXV.), and their conscious control is a matter of education. The more primitive the brain organisation, as in the lower animals, the more is the response to sensations like reflex action ; and the more organised the brain, the greater the control over the response. Another fact is that the primary propensities for self-preservation respond more impulsively than the higher powers by the rousing of the primitive emotions (fear, anger, etc.). Again, the response by a centre to sensation is the quicker the more developed the particular centre, and the higher the quality. Furthermore, congestion pro- duces greater activity than anaemia. Maniacal patients, therefore, react quickly to impressions ; whereas melancholies respond slowly, if at all. The emotions and propensities depend upon the brain organisation as much as do the intellectual capacities. Common sense tells us that the intellect and feelings are so essentially different that there must be separate centres for them. No one can suppose that the same bundle of nerve-cells and nerve-fibres which is employed in intellectual effort is that through which the emotions are manifested. The feelings of anger, fear, love, and grief arise spontaneously in us, and are as vivid the first time we feel them as they are after being often repeated. We find children show different dispositions to fear, anger, love, etc., in different degrees long before they had any experience and quite independent of intellectual influences, and we find sometimes that all the training fails in curbing the natural inchnations. If we do not admit that they are due to peculiarities of brain organisa- tion, it Avill be difficult to explain them. We shall have to assume that all character is due to education and experience, in which case no reliance could be placed on the actions of men. Education, experience, and external influences in general, may draw out the inherited dispositions and may alter them, refine them, but they cannot create them. Education can act only in proportion to the degree of development of the innate mental powers. It can sharpen existing aptitudes and dispositions, but cannot supply new ones. The character tendencies, like the in- tellectual capacities, are predetermined, and this is the reason why so frequently — to use the words of Sir FRANCIS GALTON — " a son, happening to inherit somewhat 76 THE MENTAL FUNCTIONS OF THE BRAIN exclusively the qualities of his father, will fail with his failures, sin with his sins, surmount with his virtues, and generally get through Ufe in much the same way." But tendencies are of course not •' actualities," and the growth of character is subjected to such a variety of influences that the ultimate constitution may differ considerably from the original disposition. We do not feel sorry because we cry, as JAMES contended, but we cry because, when we are sorry, or overjoyed, or violently angry, or full of tender affection — when any one of these diverse emotional states is present — there are nervous discharges by sympathetic channels to various viscera, including the lachrymal glands. This view that emotions are not of visceral origin is in accord with the experi- mental results of SHERRINGTON, who has demonstrated that emotional responses occur in dogs in which practically all the main viscera and the great bulk of skeletal muscle have been removed from subjection to and from influence upon the brain by severance of the vagus nerves and the spinal cord. In these animals no alteration whatever was noticed in the occurrence, under appropriate circumstances, of expressions of voice and features, indicating anger, delight, or fear. The argument that these expressions may have been previously estabUshed by afierent impulses from excited viscera was met by noting that a puppy only nine weeks old also continued to exhibit the signs of affective states after the brain was disconnected from all the body except head and shoulders. Evidence from uniformity of visceral response — and evidence from exclusion of the viscera — are harmonious, therefore, m pointing towards central rather than peripheral changes as the source of differences in emotional states. The intellect and the emotions must be related to different parts of the brain, otherwise it would be difficult to account for the fact why there so often exists a Wide difference in the same individual between the moral character and the intellectual capacity, and why in lesions of the brain the conduct may become altered while the intellect remains unaffected. If the feelings and propensities are not related to the brain, we should fail to account for the fact that in brain lesions they become changed — the reUgious man becomes irreligious, the benevolent man hard and cruel, the affectionate man neglectful of his family ties and obUgations, the amiable and even-tempered man irascible without provocation, and so on. When a man goes mad, the primary disorder usually consists of a lack of control over his feeUngs, which afiect the course of his thought and consequently of action, without disorder- ing the reasoning processes in any other way than by supplying him with wrong materials. " It will not be denied," says RAY (" Jurisprudence of Insanity," p. 163), " that the propensities and sentiments are also integral portions of our mental constitution, and no enlightened physiologist can doubt their manifestations are also liable with the organism to derangement and disease. That a man may be morally insane with intellect unimpaired is a position that may now fairly be assumed without question." Yet according to HOFFDING ("Outlines of Psychology," 1891, p. 349), "both talent and character are determined by the temperament." (!) That the primary emotions must have their separate centres in the brain is shown by their effects. Fear, sorrow, and depressing emotions in general lower the muscular innervation, constrict the arteries, slow speech, slacken the association of ideas, and lower the vital functions ; whereas joy and anger increase the fnuscular innervation, dilate the arteries, and increase the volubUity of speech and the general energy. Further and more convincing proofs will be found in the succeeding chapters, where we deal with each emotion separately. The number of cases we shaU cite there, accurately observed and recorded, in which injury of the brain affected one particular emotion or propensity, according to the locality on which it THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 77 was inflicted, while in other respects the individual remained perfectly sound, can only be explained on the principle that the several portions of the several hemi- spheres have different functions allotted to them. Meanwhile attention must be drawn to the fact that it is through the sympathetic nervous system that every bodily function can be affected by an emotion, and vice versa. The brain, besides being the organ of mind, is also the great regulator of all the functions of the body, the ever-active controller of every organ. Pbr this purpose it has a double set of nerves ; firstly, the cerebrospinal nerves, which in the normal state are more or less under voluntary control, enabling us to move our muscles and limbs ; and, secondly, the so-called sympathetic nerves, which are not under our voluntary dominion. The latter go to our internal organs and to the arteries, controlling the local blood-supply and thus nutrition, and also to the spinal nerves, thus exerting a brain control over our intentional movements. In this manner — and this is only a rough outline — all organs and all functions are represented in the brain, and are so represented that all may be brought into the right relationship and harmony with each other and converted into a vital unity. Thus mind, motion, sensibility, nutrition, repair and drainage have their governing centres in the brain. Thus certain states of mind are apt to be accompanied by various derangements of the functions of the body. Everyone knows how the receipt of an unpleasant letter may make us lose all appetite for food, and even cause us indigestion or headache ; how fear may actually paralyse the muscles and keep us " rooted to the spot" ; how sudden shock will sometimes result in instant death ; how long-continued grief or mental strain will sap the strength of the body. And it is no less a fact of observa- tion that when healthy mental states are substituted for unhealthy ones, the functional derangements of the body tend to disappear again. On the other hand, it is owing to the same organisation that our mental dis- position can be influenced by the bodily functions. Nobody is constantly the same self. Not only is he a different self at different periods of his life and in different circum- stances, but also on different days, according to his different bodily states : sanguine and optimistic, gloomy and pessimistic, frank and genial, reserved and suspicious, apathetic or energetic. Although his intellectual powers remain the same, his judgment of the objective world and his relations to it are quite changed, because of the change in his moods and in the bodily states which they imply. The subtle working of the sympathetic nerves may be witnessed by anyone in the habit of making physiognomical observations. He will see the flush of sudden anger, the pallor of sudden fear, the damask hue of overtaxed modesty, and the deeper tint of actual shame, the quasi-electric glow (in both cheek and eye) of radiant hope, the jaundiced hue of malignant jealousy, and the ashen bloom of suppressed (and postponed) vengeance. Each of these circulatory changes is a visible sign of the working of the mind through the sympathetic system ; but the internal and invisible effects are much more powerful and quicken or retard practically every bodily process. Without giving any further illustrations, it will be admitted that there is ample evidence of the interaction between mind and body, i.e., of the physical effects of mental causes and the mental effects of physical causes. We need not go into details, so long as it is admitted that not only can the body be weakened through the agency of the mind, but it can be strengthened also by that same agency. If the emotions and propensities arise previous to experience and vary in degree according to the inherited predisposition, they must have their brain centres from which they originate, the same as the intellectual capacities have. But this is an assump- tion which is still most emphatically denied. The statement will be supported presently with abundant evidence ; but first let us examine the reasons for its non- acceptance. First of all, to make trustworthy observations on this subject we must be both 78 THE MENTAL FUNCTIONS OF THE BRAIN physicians and psychologists ; but seldom indeed are the two combined. The mind is regarded as the province of the psychologist, who as a graduate in philosophy knows nothing of the brain, or has only second-hand knowledge which renders him apt to accept whatever brain theory happens to be in fashion at the moment, and to speculate on the same, while the brain is turned over to the anatomist, physiologist, or pathologist, i.e., to the doctors of medicine, who not infrequently know little of the mind and its elements. The view that the emotions and propensities have their centres in the brain in- dependent of the intellectual centres is opposed by modern brain physiologists principally on the ground that the emotions are all-pervading, affecting the whole body and exercising their influence over the entire brain — over every idea. This statement is quite correct, only it does not disprove our theory. Each emotion gives an impulse to the brain different in kind, and, if there be anything like order, must travel along different nerve paths, and though the effect of such an impulse may be an all- pervading one, there must be a centre from which the impulse starts. We might as well say that Bright's disease is a disease of the whole body, and not of the kidneys, because a great many parts of the organism may be affected by it. Thus, GEO. W. CRILE, Professor of Surgery, in an admirable study of "The Origin and Nature of the Emotions " (Philadelphia and London, 1915), starts from the point of view that the emotions affect the whole brain, whatever their kind. He gives a mechanistic explanation and holds nurture, not nature, to be the originator, maintaining " not that man is in large measure the product of his environment, but that environment has been the actual creator of man." Another objection is that each idea appears to have its own emotion. This objection arises from ignorance of what are the primary emotions. Sensations and ideas arouse feelings, which may occur simultaneously with them, but they are not the feelings. On the contrary, it would be truer to say that every emotion is accompanied by an idea, for the feeling arises fii:st and we seek for a cause. The sight of cruelty arouses a feeling in us just as surely as does the sensation of pain inflicted upon our bodies. We cannot infer that the feeling aroused by seeing another suffer comes to our mind through the channels of visual sensation or even visceral sensation, else why should not the same sight always produce the same effect upon us ? Instead of the same feeling, we find a bewildering variety, ranging from fear and horror to compassion and resentment. Any idea may exist associated with almost any emotional state ; it may also exist without the co-existence of any emotional state. Any simple emotional state, as fear or anger, may exist without being associated with any idea, without the simultaneous existence of any thought. A man may not be afraid ; the individual simply suffers from fear, not from fear of something. Moreover, there is no relation between the intensity of emotional and intellectual action going on at the same time, as we should think must necessarily be the case if these two were functions of one and the same part of the brain. In any given individual the intellect may be highly developed and the emotions very ill developed, or the reverse. True, we cannot recall feeUngs as we can intellectual experiences. For example, feeling happy is not the same as having the idea of happiness. Still, if it can be shown that injury of one part of the brain is followed by undue manifestation of anger, and that of another part by excessive fear without adequate cause or without any cause (see cases in succeeding chapters), the connection between certain funda- mental feelings and definite portions of the brain must be admitted. Another objection is that the emotional parts of the mind cannot be so divorced in operation from the intellectual that the one can become insane, the other remain- ing perfectly sane. But that is exactly what is the case. For example, in the early stage of melancholia there is a vague anxiety that THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 79 cannot be accounted for by the patient, who is quite free from delusions, and observes and reasons quite clearly. His mental machine — his thoughts and actions — will work more slowly in this condition, but quite correctly. In the next stage he will try to find some reason for his indefinite fears that make him feel so miser- able, and he then may exaggerate some mistakes he made in his earlier life, of which in his health he has taken little or no notice, and may put down the cause of his depression to them ; but he is still inventing nothing. He did make the mis- takes, though they are not of such importance as to cause so much and so persistent an anxiety. In paranoia also we get in the early stages a purely emotional change consisting of an exaggerated feeling of suspicion. In trying to seek evidence for it, the patient will misinterpret the looks and actions of people whom he meets, but he does not reason incorrectly, only his suspicion supplies him with wrong facts, just as it does in the case of a jealous person. He will do his work, at this stage at all events, as well as ever, and it is only when we touch upon the subject or object of his suspicion that we can notice something wrong with him. Another argument against our view — rather old, but again revived — is that the source of our feeUngs is to be sought in the activity of the visceral functions. With this objection we have dealt already, and need only mention here that the viscera may cause slight alterations, or, rather, accentuations, in our feeUngs, but they do not create them ; for perfectly healthy persons may all their Hfe be possessed by undue fear, making them cautious and prudent in all their actions, and others may ex- perience the emotion of anger more frequently or more strongly, giving them force in opposition, indignation at affronts, and energy in execution of their plans. We ail differ in our primary emotions quite independently of the state of the viscera. The question, however, is not so much whether specific emotions originate in a limited brain area, but whether the fundamental propensities — the original instincts of animals and man — are connected with the brain or not. This question seems never to occur to physiologists and brain surgeons. It is always the intellect and its meta- physical elements that are inquired into ; but, surely, if any mental qualities are related to the brain, it is those elementary instincts which are common to all animal creation for the preservation of their existence. Otherwise of what use is their brain ? It is positively wearisome to go through thousands of reports of cases of head injuries, brain tumours, and other lesions affecting the cerebrum and read invariably that the symptoms observed were " mental depression," " restlessness," " diminished attention," or " loss of concentration " or of " memory." Such vague statements can be made of any person, whether suffering from a cold in the head or pain in the big toe, and need no cerebral lesion. The vast number of cases which I shall quote in the next three chapters may not all be suitable cases to prove my arguments, but they are the average that can be found in medical literature for the present, and all that is intended with them is to give an impetus to an inquiry into the whole problem on new lines. Then there are those who oppose not only the view that the primary emotions and propensities have their origin in special centres of the brain, but oppose all localisation whatsoever. Most of them are still imbued with the metaphysical notion of the unity of the ego. But do not the bodily organs — the heart, the lungs, the stomach, and the kidneys — work simultaneously ? Why should not the different brain centres, which are also organs for specific functions, work simul- taneously in their respective departments ? Consciousness is only a phase of that nervous work. We read a book which excites our imagination. The printed words and sen- tences are observed. Their memory images are associated with the speech centre ; the words read may be heard. From the speech centre are called up the images of visual centres. While this goes on our imagination gives us illustrations of what we 8o THE MENTAL FUNCTIONS OF THE BRAIN have just read, and our eyes perceive in advance another line of words. At the same time, we observe what goes on outside our book in the field of vision with a little less attention, and the ear takes in sounds, say of a band that passes our windows. We notice the melody and at the same time we notice a printer's error or criticise a badly constructed sentence. The melody may remind us of something that happened in our life. All this may go on without our being really distracted. This shows that our ego is formed of parts grouped together like a mosaic. Such objectors labour under the mistaken view that each centre could or would act independently ; but though the centres themselves are distinct, all of them are inter-united, and the activity of each depends on its relation to the others. No one centre is competent to manifest itself by itself. Each acts as a certain portion of the brain to modify the general result of cerebral action. The different centres are only points of highest activity of a special function, but none of the functions can be completely disjointed, for each specialised group of cells is connected by nerve fibres with a number of other groups, so that when one centre is roused into activity the greater part, if not the whole, of the brain may tingle in unison. All centres may therefore be regarded as association centres. It is through this solidarity and interdependence that no portion of the brain can be injured or exhausted without its interfering in some way with the functions of the other portions. There is, however, a great difference between saying that the various brain parts exert a mutual influence, and saying that each part does not perform its own particular function. Were the cortex of the brain a single organ, then the innate dispositions of each man would be similar. But if the various convolutions of the brain be appropriated to different mental powers, then does every modification of character depend on a different degree of development attained by these particular parts of the brain and their varying degree of activity, one man reacting to certain stimuli with anger, another with fear, another with sympathy, and so on. Every group of cells has multiple connections with other groups and may therefore be affected by a series of impressions difierent in origin and, to a certain extent, also in nature. Their function is therefore very far from being limited to a single form of stereotyped activity ; but at the same time it does not consist in an indefinite capacity to receive any kind of stimulus. It is simply impressionability by a certain number of minimal stimuli, subconscious and different from each other, but probably little dissimilar, which come from various parts by pre-estabUshed anatomical paths, sometimes along with others, sometimes in little processions, according to circumstances. Every group of cells acts both as an organ for recep- tion and an organ for discharge, inasmuch as it can pass on to other groups of cells the stimulus it has received. As an organ of reception it can be impressed with various stimuli, and it has the same versatility also as an organ of distribution, passing on to near or distant cellular groups, with which it is anatomically con- nected, one or other impression, according to the circumstances of the moment. The course of thought is, therefore, very precarious. Its variations depend not only upon external events, but also upon the intimate changes in innumerable cells, which form part of the system accessible to a given nervous current, and which are each independently able to attract or repel this current. Theoretically the psychical process should be able to reach without limitation to any point with which there is anatomical continuity ; but practically it encounters resistances and attractions, sometimes of a transitory nature, which do not allow it either to go beyond or to stop short of a given course. On account of this dynamic variability, the nervous currents, proceeding from the same point of origin, can assume an almost infinite number of material figures in the cortical space and of subjective figures in con- sciousness. This conception of psychical centres does away with the objection that the number, extent, and topographical arrangement of the cortical centres, being determined by the fixed order of embryological development, cannot present great differences in one individual as compared with another, and still less from time to THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 8i time in the same individual, and that this renders inexplicable the infinite variety of ways in which images, ideas, and emotions follow one upon another, even under the same external conditions. — (Tanzi.) The position of the centres is not accidental, but is governed by fixed principles. One centre fuses with another, hence neighbouring centres are related in their mental manifestation. Centres are of a higher character, and of later acquisition, in proportion as they occupy a higher locality in the brain. Thus the highest mental powers will be found farthest from the base of the brain, for the rigid base of the skuU does not admit of much expansion. On the other hand, the vault of the skull remains open in two places at least for some time after birth, and even in later life is still capable of an increased arching to make room for increased brain mass. The lowest and most indispensable mental powers — for instance, the instincts of self-preservation common to men and animals — will be found at the base of the brain. The greater the moral and spiritual energy of a man, the higher seems to be his head ; the more animal energy a man possesses the broader his brain at the base. We need only compare the heads of the really great men of the Church with, say, those of prize-fighters, and the fact will be apparent even to an unskilled observer. It is a mistal(e to draw conclusions from animal physiology to human physiology as to the mental functions of the brain, as has been the fashion for the last fifty years. To mention only one fact : a slight blow to the human head may render a person insane, whereas, if we are to beUeve the physiologists, large portions of the brain of an animal may be extirpated without affecting its mental condition. These traumatic lesions are often highly instructive for cerebral localisation, for they are not only hmited in the area they involve, at all events at the time of the accident, but they are limited in the damage they do to the mentality of the victim, usually one or more mental powers becoming deranged, while in other respects the individual remains perfectly sound ; and whenever the injury affects the same locality, the same mental power suffers. Similarly circumscribed lesions due to the growth of tumours, the effects of haemorrhage, etc., give rise frequently to definite mental changes by pressure on a hmited brain area producing degeneration of the surrounding brain- cells. Such lesions may be described as Nature's own experiments, and, being made on man himself, are much more trustworthy and instructive than the experiments on pigeons, guinea-pigs, rabbits, cats, dogs, and monkeys conducted by phj'siologists. As long ago as 1814 Sir EVERARD HOME, a famous surgeon (see Chapter XI.), in a paper in the Philosophical Transactions of the Royal Society, proposed keeping accurate records of brain injuries and the mental powers which become sub- sequently affected. "The various attempts," said he, " which have been made to procure accurate information respecting the functions that belong to individual portions of the human brain having been attended with very Uttle success, it has occurred to me that, were anatomical surgeons to collect, in one view, all the ap- pearances they had met with in cases of injury of that organ, and of the effect that such injuries produced upon its functions, a body of evidence might be formed that would materially advance this highly important investigation." Some fifty years later Sir FREDERIC BATEMAN {Journal of Mental Science, 1869) wrote : " Traumatic cases may be regarded as veritable vivisections, and their study is invaluable in an etiological point of view, as contributing perhaps more than any other class of cases to sound ideas as to the question of the cerebral localisation of our divers faculties." Still later, WILLIAM JULIUS MiCKLE, in a paper on "Cerebral Localisation," wrote : " In the human subject, strictly limited traumatic brain lesions are among the pathological conditions which bear most clearly upon the problem of cerebral locahsation. Necessarily these accidental experiments upon the human brain are sometimes as sharply localised as are the experiments of the physiologist upon the Vol. ii.] ^ a l^St^t 82 THE MENTAL FUNCTIONS OF THE BRAIN brains of lower animals. For the purpose of the physician, indeed, they are more instructive than the latter." Experiments on animals can produce only motor and sensory phenomena, therefore physiologists lay stress on them, and, clinical observation not coming within their range, they are apt to undervalue it in comparison with their own more exact research. But now that laboratory physiology has evidently done all it ever will do in elucidating the functions of the brain, any further advance must be made by observing the effects of injury and disease on man, since man is the only animal that can communicate his feelings, sensations, and thoughts by means of speech. These chnical observations have never been made systematically. The neurologists — one section of the medical profession with special opportunities for them — specialise in motor and sensory phenomena and therefore place their faith in the information physiologists put before them. Mental changes, if they are observed by them, refer principally to visual, auditory and speech phenomena ; but with reference to mind proper as including intellectual capacities, sentiments, emotions, and propensities — these are rarely noted by them. Most of them do not admit any relation of emotions to brain centres, and changes so severe as to amount to insanity do not come within their sphere. As a proof of my statement I need only refer to the French report on head injuries in the recent war, based on 5,000 cases (" Wounds of the Skull and Brain," by CH. CHATELIN and J. de MARTEL, London, 191 8). Mental symptoms (except afiections of sight, hearing, and the other senses) are denied by the authors — and after reading their book one really wonders whether insanity can be a brain disease. The alienists, whose proper department is mind and its disorders, have no opportunity of collecting such material, for there are no real " hospitals " for the insane, and the asylums, though now called " mental hospitals," admit only ad- vanced and more or less chronic cases. Our asylums are like monasteries on beautiful heights in the country, sur- rounded by big walls, which not only prevent the escape of patients, but, by the rules with which these institutions are governed, prevent anyone but its salaried officers making clinical studies in them, and burden these officers with so many administrative duties, that only those who really love their work and are bom with a gift for it ever make any contributions to our knowledge of the subject. No wonder that until a few years back it was frequently denied that there is any difference between the brains of sane and insane ; and now, when we have a fair number of pathological laboratories connected with asylums, the only definite facts we possess are the appearances of brains in amentia and dementia (progressive, alcohoUc, and senile). It is to be borne in mind that the insane upon whom we make autopsies in asylums almost always die in states of advanced dementia, or in consequence of intercurrent diseases, which, both of them, produce alterations in the brain, often entirely difierent from those connected with the psychosis and, wholly or in part, obscure the original characteristic changes. Moreover, localisa- tion of mental function in the sense here described not being admitted, the pathologist takes at random slices from any part of the brain and examines the microscopical appearance of the brain-cells, usually most carefully and minutely ; but his descriptions, however valuable from other points of view, do not help us in the solution of this most important problem. All honour to the men who make these researches, they have immensely advanced our knowledge of the structure of the brain and its morbid changes ; but their views on localisation, for or against, are still based only on surmise, since the theory has never been tested systematically, as we propose to do in succeeding chapters. THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 83 It is rare that we get clinical cases with post-mortem observations reported from asylums. Most mental cases recorded in medical periodicals are by neurologists ! A sound localisation theory would enable us to point to the seat of the disease and to treat it as may be required ; but to those who oppose the theory, it matters nothing whether a person be melanchoUc, violently maniacal, homicidal, or suffer from delusions of persecution, whether he be a kleptomaniac, a rehgious maniac, or fancy himself a milUonaire ; in every case they assume that the whole brain is afifected. Unfortunately, those who do not expect to find localised areas of disease are not looking lor them, and have no inclination to examine the evidence others put before them ; hence our knowledge of this subject has made little progress. But if we are disputing one of the most elementary problems of the functions of the brain, what advance can be made in the treatment of the insane and feeble-minded ? The unfit are ever increasing, and Royal Commissions are appointed to investigate the causes of this increase, but what is the good of all these inquiries when we are not yet agreed on the fundamental question of the functions of the brain : Is localisation of mental function possible ? But what about the surgeons ? Have they not operated in thousands of cases in this war alone for localised head injuries, and are they not the best judges of the problem before us ? They might be, but, so far, they are not. First of all, the surgeons are generally in a hurry, necessarily so, and have no time, even if they have the opportunity, to make detailed examination of the patient's mentality or to follow up the case. Thousands of operations have been performed in the recent war for injuries to the skull and brain (notice the French report just referred to), and as in olden times, so now, the statement is made in the medical reports that the patient sufiered neither loss of intellect nor change of character, though he lost an appreciable quantity of brain-matter. The surgeon may be right, but he should state what sort of examination he made into the mental condition of the patient and how long after the operation he had him under observation. It has been my experience that, whenever a patient is able to return a rational answer to any simple question about his health, the surgeon and attendants invariably speak of him as in full possession of all his faculties. So long as the patient can answer ordinary questions about his food, number of his family, his location at the time, and attend to his bodily wants with some care, he is considered not to have shown any mental sjnnptoms. But I have had the opportunity of following up several of these cases, and discovered not only some with loss of definite intellectual capacities, and certainly diminished vigour of these powers, but in a great many instances marked emotional changes — from previous cheerfulness to melancholy, from gentle peacefulness to irascibiUty, from affection to hatred, from honesty and truthfulness to deceitfulness and criminal tendencies. Are these changes of character and conduct not also due to the brain lesions ? I am in a position to af&rm that, if such changes were taken notice of at the time, or the possibility of their later develop- ment were recognised, measures might be taken which in many cases would save a man from the workhouse, prison, or asylum. The man with a serious brain injury has few needs, few thoughts, few feelings, and is only semi-conscious ; the questions usually put to him convey no information about his r^al state. Let us follow up the history of such a case after the patient has returned to ordinary life, and a different picture wiU be presented. He is not the man he was before. A man may give rational answers to questions put to him at the bedside of a general hospital, and yet be totally changed in character since his illness commenced. How is the surgeon to know unless he has some knowledge of the state of the man's intellect and dispositions during health ? He may have suffered a great diminution of energy, so that he is altogether incapable of following a chain of reasoning, or comprehending a line of detail, to which, when in health, he would 84 THE MENTAL FUNCTIONS OF THE BRAIN have been much more than adequate. Nothing is more usual, in ordinary Ufe, than to see a person a httle unwell cease work from a consciousness of incapacity ; even a common cold can cause diminution of mental vigour, and yet a severe gunshot injury is sometimes stated to have made no difference to the patient's mental capacity. This is generally due to the superficial examination resulting in such vague statements : " The senses were retained to the last " ; " All the faculties remained entire " ; " He had his consciousness entire, viz., he knew all around him." Sometimes we find it stated, " Memory was impaired." Which memory ? Even in health not all our memories are the same. The memory for facts, events, tones, dates, numbers may be excellent, and the memory for proper names atrocious. Where is the clinical assistant who inquires into these details and tries to discover what they were in health and what they are now in disease ? " If the patient is free from delirium and can say ' Good morning,' and put out his tongue when told to do so, it is recorded that ' his mental faculties remained entire,' that ' there was no deficiency of intellect,' or that ' he was clear and collected to the last.' This testimony, of course, to be of any value, necessarily supposes a skilful and exhaustive exploration of the mind in all its departments, and a scrupu- lous attention to minute and intricate details in each particular case. Being founded, however, only upon the most superficial examination, it is not merely valueless but mischievous and misleading. To evidence of this kind must, I beUeve, be traced many fallacies which have impeded scientific progress, such as the state- ment that a whole hemisphere of the brain may be destroyed without the mind suffer- ing in any way, or that every part of the brain has been found disorganised in one case or another, without any derangement of the mind having existed." — (Sir James Crichton-Browne.) " That mental symptoms or mental deficiencies have not been recorded in cases of bilateral cerebral lesions is a negative statement of very little value. Unless a man becomes so demented as to neglect the ordinary wants of nature, or so furious, maniacal, or irrational as to require restraint, there are few engaged in the practice of medicine who think of inquiring narrowly into a patient's mental state, and, even if more attention were directed towards this subject, are we in possession of any means of accurately gauging the mental condition of an individual so as to be certain that it has altogether escaped damage, notwithstanding the presence of a cerebral lesion ? I see little to justify, and much to contradict, such an assumption. A man may not be incapacitated for the ordinary duties of Ufe, but that his mental powers are altogether unscathed, even by a unilateral lesion, I venture to question." — (Sir David Ferrier.) " Every structure in the nervous system has a specific function, and if a portion is destroyed it cannot be replaced anatomically, and, from the point of view of function, the compensations which are provided indirectly are always far from being complete. If in such cases no defect is recognised, it must undoubtedly be due to insufficient methods, to which may be added perhaps a want of patience on the part of the observer. "( — Ernesto Lugaro.) It is not uncommon to find patients years after a head-injury, when it has been forgotten because it left no outward sign, present symptoms of mental deterioration due to degenerative changes set up in the cortical layers of the hemispheres. The mischief produced may be out of all proportion to the apparent severity of the lesion, and therefore such injury should never be lightly regarded. Often it is only some local irritant to the membranes of the brain — such as a splinter of bone, accumulation of fluid, etc. — ^while the brain itself remains perfectly sound. In such cases cranial operation is all that is needed for the relief of the patient and the more alarming brain surgery need not be undertaken. From the cases quoted in the succeeding chapters it will also be apparent that there is no limit to the time that may elapse when surgical treatment may still be successful, some of the cases having THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 85 been treated three, four, eight, and eleven years after the accident, one case after twenty-five years, and one even after thirty-one years. The instructive matter in these cases is that the moral character is usually Im- paired first, and sometimes is completely perverted without a corresponding deteriora- tion of the understanding. And still we find physicians and surgeons who neglect to inquire into the condition of the emotions and propensities in brain lesions, and proceed as if the human mind consisted of intellect only. Do we not find in ordinary ailments an increase of irritability or emotionality ? Why, then, should the state of the feeUngs be overlooked in brain affections ? The feelings may be changed with- out any affection of the intellect. MAUDSLEY, for example, held that " injury to the head will tend to produce intellectual disorder rather than emotional de- pression, while abdominal diseases will favour the production of emotional depression." This lack of appreciation of the character-changes in brain lesions need not surprise us, however, for insanity has not long been recognised as a morbid condition of the brain, and it is only a little over fifty years ago that the Royal College of Physicians of London published a Nomenclature of Diseases, in which work insanity was dissociated from all other affections which beset humanity, and its varieties were comprised under the heading " Disorders of the Intellect," all connection wth the emotions being disregarded. It is due to lack of proper psychological training and knowledge of the elements of human character that the statement is so frequently made that all the faculties have been found entire after a brain lesion. But if a person of a mild and peaceable character, after a wound on the head, becomes quarrelsome and morose ; and if another, whose life had always been irreproachable, after a similar accident should feel an irresistible inclination to steal, it is evident that, though these persons preserve consciousness, memory, judgment, and imagination, we cannot thence infer that the injuries inflicted have produced no derangement of the mental functions. Do animals not possess consciousness, memory, and judgment ; but are they therefore on a level with men ? If a man were by disease reduced, in point of faculties, to the level of a dog, but stiU enjoyed the five external senses, as well as some portion of memory and judgment, would he, therefore, have lost no characteristic faculty of humanity ? If partial idiots have perception, memory, and judgment, are all the faculties of the mind manifested ? It is evident, therefore, that the mental examination of patients with brain lesions will have to be conducted on very different lines in the future if we wish to discover the mental functions of the brain. As has been shown in a previous chapter, the views on localisation are so con- flicting, that the wisest plan for physicians and surgeons to follow would be to content themselves with placing on record the facts they observe and to let them, as it were, speak for themselves. If, as hitherto, every observer has his own pre- conceived notions, and draws conclusions from one or two cases that have come under his care, his report is useless ; j ust as much as is the report of that other man whose mind is " made up " that localisation of any sort is impossible. Another necessary criticism of medical and surgical reports is the vague descrip- tion of the locality of the lesion. It is not enough to say " patient received a blow on the head, " or " there was a scar on the side of the head," without telling us what bone had been injured and what part of it. RATHMANN (" Vierteljahrschrift f. Gerichtl. Medizin," 1901) gives fifty-one cases of head injuries followed by mental derangement, most of them without indication of locaUty. As we have already said, the more highly developed the mental powers, the more connected wiU the various channels of the brain become by means of inter- communication. Though the centres themselves are distinct, all of them are 86 THE MENTAL FUNCTIONS OF THE BRAIN inter-united, and the activity of each depends on its relation to the others. It is therefore a mistake to look for a protuberance of brain-matter, or a bump on its outer covering, the skull. Let me repeat again that no one centre is competent to manifest itself by itself. Each acts as a portion of the brain to modify the general result of cerebral action. It is through this solidarity and interdependence that no portion of it can be injured or exhausted without it interfering in some way with the functions of the other portions. There is, however, a great difference between saying that the various brain parts exert a mutual influence, and saying that each part does not perform its own particular function. Destruction of a particular area, even if we know its exact boundaries, need not necessarily cause loss of a definite mental function, for no organ ever works alone ; it sets into vibration other brain organs ; just as we can rarely think of one subject or event without being reminded of a number of others associated with it, and having various feelings aroused at the same time. There must be division of labour in the cortex as elsewhere, and certain groups of cells will be occupied with preference with one fundamental psychic quality rather than with any other. We may in certain cUnical cases of circumscribed lesions discover an increase or dim- inution of activity of a special mental faculty, but I can see no other way of discover- ing its seat. Owing to these inexactitudes, the number of observations really available for scientific purposes is comparatively small. If the records of these cases were more carefully taken, both as regards the extent and location of the injury as well as to the mental changes following it, we should obtain most valuable information, whereas now this vast material is almost lost to us. Owing to these inexactitudes we read such statements as : " Abscess of the brain may exist, or portions of it may be carried away by gunshot or other injuries, and yet no perceptible difference be observed in the mentahty of the individual." After reading this one wonders what really is the use of the brain. It is only the vague, indefinite manner in which all these examples are produced that save the head and its contents from the imputation of being useless appendages. The brain is the instrument of all the mental powers, and it betrays great indifference to assert that it matters not whether the instrument be a whole or a broken one. It must, however, be distinctly admitted that instances of extensive cerebral disorganisation occur in which neither mental, nor motor, nor sensory disturbances appeared during life of so marked a character as to excite a suspicion that such things existed ; but this kind of anomaly is by no means limited to the brain. Numerous cases are recorded in which a whole lung has been destroyed, or the greater part of the liver disorganised, or a kidney has disappeared, without any Suspicion having been entertained during life of the real state of matters ; and it would obviously be as reasonable to infer from them that the lungs were not the organs of respiration, or the liver the organ of biliary secretion. The fact that is frequently overlooked is that the brain is composed of two similar halves or hemispheres, and that, consequently, all the centres must be double. The wonder is that one-sided injury so often causes an accentuation or loss of a par- ticular mental power ; for, as a matter of fact, both centres should be destroyed to cause complete loss of the function with which it is concerned. Though we may speak of a centre, it is understood that as there are two hemi- spheres of the brain, every centre is two-fold, and to this fact may be due those few instances in which a particular centre has been injured or destroyed without a loss of any mental power being discoverable. This is especially the case in accidents to the right half of the brain, which seems to be less active than the left. When the two halves are unequal, I have frequently observed that the right represents what the individual is by nature, i.e., his inherited organisation, and the left what he has made of it. THE BRAIN : THE ORGAN OF THE PSYCHIC ACTIVITIES 87 It has also to be noted that diagnosis in cases of blows to the head is often rendered difficult because of the effects of contre-coup. The head may be struck on the occiput, but the concussion causes the brain to shoot forward and impinge upon the frontal bone, where the effects may be produced. Were the mental functions of the brain better known, we should be more certain when a contre-coup has taken place, and would not have to wait for the post-mortem examination. Another difficulty is that the emotions and propensities may become accentuated by a lesion of those parts of the brain with which these are connected ; but they may also become accentuated when the lesion is in that part of the brain which has to do with the intellectual functions ; because, the intellect being impaired, there is httle or no control over the emotions and propensities. For example, it will be shown that a lesion of the lower part of the temporal lobes is almost invariably followed by symptoms of irascibility ; but a lesion of the frontal lobes by destropng the control over the emotions may accentuate an irascible disposition. For this reason we should always know the state of the mind when the patient was in health. Another puzzUng difficulty to some observers is that in lesions of the brain the particular mental function is sometimes manifested more intensely ; at other times it is diminished or lost. This is explained by the inflammation preceding the destruction of the nerve-cell. During the process of inflammation the activity of the function connected with the area involved will be stimulated to hyperactivity, and when degeneiation commences and destruction takes place the function connected with the circumscribed area will diminish or vanish. This is in agreement with the law of the " temporary excess of function in atrophy," by CLAUDE BERNARD, which is : " When a histological element dies, or tends to die, its irritability, before diminishing, begins to augment, and it is only after this exaltation that it decreases again, and gradually becomes extinct." It has also to be noted that when the region of the intellectual functions is damaged, these get lost ; but when the region of the emotions and propensities is injured, these are augmented. As a rule, the emotions become accentuated in inflammatory lesions of the parts of the brain concerned with them ; while intellectual powers appear to be lost. (For proof of this statement see suc- ceeding chapters.) For clinical cases to be of use for localisation, both the history of the disease and the description of the post-mortem condition must be trustworthy, full, and unambiguous ; and there should be no other lesion than the one in the cerebral cortex to complicate the legitimate inferences. These conditions are rarely fulfilled, and it is therefore a mistake to collect all cases indiscriminately to prove or disprove a particular theory. Thus Dr. PAUL SCHUSTER (of Prof. Mendel's PolycUnic), in his work on " Psychische Storungen bei Himtumoren," Stuttgart, 1902, examined the locaUs- ation theory (as advanced by me in outline in a pamphlet pubhshed some twenty years ago) by collecting all cases of brain tumours recorded in history and noting the mental changes produced by them, if any. He found, of course, that only rarely did the records harmonise with my theory. In the succeeding chapters I shall produce the history of some hundreds of cases of brain tumours, omitting all those too vaguely described, and it will be seen as definitely as to amount almost to a law that the mental manifestations in cases of brain tumours involving the cortex vary according to the locality in which the growth is located, and that tumours in the same region produce the same manifestations. Still, I do not claim that all the cases quoted by me are perfect ; possibly some may be objected to on closer inquiry. But whatever the defect of individual cases, I shall produce such a volume of evidence, accurately recorded beyond all question, as shall induce, not necessarily the acceptance of my theories, but a fresh in- vestigation into the whole subject of mental functions, on the Unes suggested by me ; not on the basis of former cases, but on new ones as they happen to occur. 88 THE MENTAL FUNCTIONS OF THE BRAIN It may be objected that many of the cases cited by me are not recent ones ; some might even be described as ancient. But is this really a vital objection to the theories advanced ? Such facts as I have just quoted — as that our modem students are trained to devote all their attention to the microscopical appearances of the brain in the different psychoses to the neglect of naked-eye appearances ; the prevalence of the toxin theories to account for most forms of insanity ; moreover, the lack of opportunity to study the early stages of mental disorders ; as also the fact that intellectual changes are not inquired into with sufficient minuteness ; and character changes are often disregarded altogether as not dependent on brain condi- tions ; and last, but not least, the contempt with which the localisation theory of metttal functions has hitherto been regarded — all these facts explain sufficiently the lack of adequate material. Pathologists will now know what to look for to discover focal lesions ; and surgeons will learn when and where to operate, the more frequently the more definite our knowledge of the mental fimctions of the brain becomes. Already there is a fair number quoted in which surgical operation has been performed successfully, not only in cases of injury to the head, but also in inflammatory lesions, haemorrhages, and new growths. If my theory of the physiological basis of human character — of the locaUsation of the fundamental qualities and dispositions in the brain — be right, it can hardly fail to lead to a more perfect understanding of human character, and, indirectly, to the elucidation of some of the most difficult and interesting psychological, educational, and social problems. So much is certainly evident, that not only as regards the intellectual quaUties, but as regards the strength of the primary feelings, we do not start life equally, but with advantages and disadvantages according to our in- herited organisation. The highly organised brain is bound to lead, to dictate, to govern, while the more weakly endowed is born to a life of servitude and sub- mission. From this it follows that no uniform system of education is in conformity with nature ; moreover, it becomes evident that' parents and teachers must train the feehngs and propensities as well as the intellectual capacities of children, since the former as well as the latter depend on the inherited brain organisation, and the feelings supply the motives to the exercise of the intellect, and on their proper development and restraint depends the whole character and thus the future of the man. This question of localisation of function is of the highest importance both to the psychologist and the physician. Those who admit that the primary mental powers have separate centres in the brain will condemn uniform methods of education and lay stress on individual training according to the organisation. The localisation theory will enable us to explain abnormalities of character and to trace them to their cause ; and, speaking as a brain -specialist, the localisation theory is of the greatest importance in the diagnosis and treatment of those early stages of mental derangement when the pathological changes have not yet advanced too far and the patient is not mad enough to be certified as insane. In conclusion, let me repeat that I do not wish anything contained in these pages to be taken for granted. I shall be satisfied if I can claim to have indicated the hnes on which future research might be undertaken with better results than have been hitherto achieved. CHAPTER XXIX INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN We have seen that there are elementary feeUngs and propensities which man and animals have in common, and which exist for the preservation of the animal and man without consciousness, reflection, or active participation on the part of the individual being necessary. But if it be admitted that we have elementary feelings in common with animals and are distinguished from them by our greater intellect and higher sentiments, and if it be admitted that all mental operations take place in and through the brain, then we must presume that we have some parts o! the brain in common with animals and some which are distinctly human. This is proved by comparative anatomy. If we take the lowest animal which has a rudimentary brain, and observe the gradual development throughout the whole species of animals till we reach the highest apes, whose brain most closely resembles that of human beings, we shall see that, in accordance with the gradual development of the reasoning capacity of animals, there is a part of brain, corresponding to the frontal lobes in man, which correspondingly increases in size and is relatively largest in the gorilla, chimpanzee and orang-outang, though their frontal lobes are still smaller in size than those of the lowest human idiot. As the other lobes in man and animals show no such disproportion, we may draw the inference that the frontal lobes are related to functions which are distinctly human, that they are the instruments for abstract thought and the higher intellectual operations, and possibly for the higher human sentiments. Again, if we study embryology and observe the growth of the human brain, we shall find that those parts which are the latest and highest acquisitions grow last, and that as the reflective and reasoning faculties are latest in arriving at perfection, the frontal lobes are the last to develop. If we now examine the brains of microcephalic idiots, we find that the arrested development is chiefly in the frontal lobes. Indeed, if we compare the frontal lobes of imbeciles with those of men distinguished for their intellectual qualities, we fiind a great contrast in their size, though the remainder of the hemispheres has at- tained to normal growth. The contrast is more eloquent than any language can express. On the other hand, it is not to be overlooked that examples of idiocy and imbecility are not rare where the head is of average size and shape, and where the mental deficiency is congenital through an insufliciency of neuronic elements. As the deficiency of the frontal lobes is not accompanied by a corresponding deficiency of the rest of the brain, the emotional life of all the higher idiots, as of all the higher animals, is remarkably vivid as compared with their intellectual life. All the propensities and emotions are present, except the higher emotions — the ethical, aesthetical, and spiritual — which belong to the frontal lobes, as we shaU show. True, their emotions are not profound. A trivial event wUl make them laugh or cry, and it is easy to hurt their feelings with a slight ofience ; on the other hand, the death of a dear relative is very soon forgotten, while the stronger passions do not 90 THE MENTAL FUNCTIONS OF THE BRAIN occur with that force and persistency common to normal man. The higher faculties, that belong to the frontal lobes, as I said, are absent. There is, for example, no idea of right and wrong. The higher idiots do experience a feeling of remorse on offending the sympathies of those whom they love ; but, it seems, some dogs know when they have done wrong and hide themselves from their master. There are a number of anthropological facts in favour of the view that the frontal lobes are related to the intellect. The expansion of the frontal lobes in men engaged in intellectual pursuits has been repeatedly demonstrated by actual measurements. It has been shown that the frontal lobes vary in size and Aveight in different races according to their in- tellectual capacity. Anthropologists have demonstrated from examination of European skulls that the progress of civilisation has resulted in raising the anterior and flattening the posterior part of the head. HERMANN WAGNER (1840-), inspired by his father, RUDOLF WAGNER (1805- 1 864), in 1864 compared the mean proportions of the cortex in man and the orang. The occipital lobes proved larger in the orang than in man, while the frontal lobes were considerably smaller. He also weighed each lobe of the brain of Gauss, the mathematician, and of other eminent men, and compared it with the weight obtained from the brains of working-class men. The workmen had the smallest frontal lobes, but larger occipital lobes than the celebrated mathematician. GRATIOLET (1815-1865) distinguished the principal divisions of our species by that bone of the skull which is relatively the largest. Thus (i) Frontal or Cau- casian ; (2) Parietal or Mongolian ; (3) Occipital or Ethiopic. He has shown that in the Caucasian, the anterior fontanelle is the last to ossify, and thus permits of the greatest possible development to the frontal lobes ; and that in the Ethiopic race the converse condition obtains, the posterior fontanelle being the last to ossify. According to this arrangement, in the superior races the frontal lobes of the hemi- spheres continue to develop for a long time after the occlusion of the posterior sutures has put an end to the growth of the rest of the brain ; in the inferior races, on the contrary, the ossification of the sutures proceeds from before backwards, and, thus the anterior parts of the brain are first arrested in their growth. The important researches made in reference to ancient skulls by the ABB t. FRERE, whose rich collection is in the Anthropological Museum at Paris, led him to the conclusion that the skulls of Europeans have increased in size since historic times ; and that the progress of civilisation seems to have resulted in raising the anterior and flattening the occipital part of the skull. PAUL BROCA (i 824-1 880) examined the heads of thirty -two house surgeons who had successively resided at the Bicetre during the years 1861-1862, and compared their dimensions with those of the heads of twenty-four porters attached to the various wards of the same hospital. This comparison resulted in the confirmation of the generally received opinion, that the anterior lobes are the instruments for the higher intellectual operations ; and Broca considered that he had demonstrated that the cultivation of the mind and intellectual work augment the size of the brain, and that such increase affects chiefly the anterior lobes. (" Revue Scientifique," 1861-2.) J. B. M. PARCH APPE (1800- 1866) also made measurements and found that the frontal lobes in men of learning have much larger proportions than in common working men. LACASSAGNE and CLIQUET have examined, by aid of the conformateur, the heads of 190 doctors of medicine, 133 rudimentarily educated persons, 90 illiterate persons, and 91 prisoners (soldiers), with the folloAving results. There was a considerable difference in size of head in favour of the doctors, and this was especially marked in the frontal measurement. In the educated, the frontal region was more developed to the left, and was altogether proportionately more developed than the occipital region, which was the larger in the case of the illiterate. ALEXANDER MacALISTER (1844-1910), Professor of Anatomy, at the British INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 91 Association Meeting, Edinburgh, 1892, declared that " increased growth of the frontal lobes is the physical accompaniment of intellectual activity." THEODORE MEYNERT (1833-1892) found that in normal brains the ratio between the weight of frontal plus temporal lobes and the weight of parietal plus occipital lobes is as 6 : 3. In dementia paralytica and dementia senilis this quotient is 5 : 4, showing that the frontal lobes and temporal lobes have lost the most. SCHRODER VAN DER KOLK {1797-1862) wrote : " That to all parts of the cerebral convolutions are not assigned exactly similar functions was long ago suspected. Further, that a finely arched forehead indicates, as a rule, high intellectual endow- ment was already not unknown to the Greeks, as we may conclude from their delineations of Jupiter, Apollo, and so forth. The strongly prominent forehead as the prerogative of man came yet more definitely into view when Camper proposed the facial angle named after him, and pointed out its difference in Azteks, Negroes, and Europeans, in children likewise and in grown-up persons." WTienever decided talent is found conjoined with a small frontal region — small in all its dimensions and relatively to the other regions of the brain and to the body generally — there will also invariably be found a vivid and energetic temperament and such propensities and emotions which act as a stimulus to the intellect ; or else however little there is of the intellect has been concentrated upon that particular field of study for which there is some natural gift. Energy of character, industry, application, often make up for natural talent. On the other hand, one can see everywhere plenty of big foreheads, high, broad, and with a large base from the opening of the ear to the outer corner of the eye — so that we may presume large frontal lobes, without their possessors being remarkable for intellectual ability either general or in one particular. There are various reasons to account for this, the most common being that the brain has never been stocked with icnowledge, or only with trivial information such as a cheap Press supplies ; the person may be easygoing, lack nervous energy, application, or, what is not un- common, he may be a mere dreamer. Remarkable foreheads may be seen amongst working-class men. Some do not show any special knowledge, but sound, practical views on the problems of life, while a great many others have studied for themselves politics, political economy, and even special sciences, in which they excel. But we must iool( for something more than an apparently large forehead for a sign of intelligence, ability, etc. The head must be well proportioned all round ; otherwise, if the sides or the back of the head predominate over the front, the intellect will be merely in the service of the functions of these parts. I shall show — on the strength of a large number of clinical cases by independent observers — that over-stimulation of the frontal lobes by hyperaemia, congestion, etc., leads to : (i) A joyful disposition, and in its trend extreme hopefulness, feeling of well- being, mental exaltation, delusions of grandeur and ambitious dehrium (a false behef of possession of honours, fabulous property, and extraordinary mental capacities) ; (2) A state of mania, namely hypomania. (3) When the stimulation amounts to congestion, paralysing the frontal brain- cells, or destroying them, there Avill be loss of self-control, i.e., loss of inhibition over emotions and propensities ; consequently loss of ethical, aesthetical, and religious sentiments (and through the loss of inhibition, the patient seeks immediate gratifica- tion of his desires). Further, it will be shown that destruction of portions of the frontal area leads to : (i) Loss of active apperception ; (2) Defects of memory ; 92 THE MENTAL FUNCTIONS OF THE BRAIN (3) Defect or loss of logical reasoning ; and when involving the greater part of the substance, there will be (4) Dementia. The larger the frontal lobes, the greater the power of inhibition, suspending and postponing the immediate and direct pursuit of an end, a step which lies at the root of all progress, civilisation and morahty. The larger and more perfect the frontal lobes, the more reasoned adaptation enters into the action of instinctive tendencies, and the greater the self-control. Experiments on animals confirm the view that the frontal lobes are the centres of perception and reflection, and the centres of inhibition against the instinctive impulses, so that they form the basis of the moral sentiments as far as their rudi- mentary existence can be demonstrated in the lower creatures. HITZIG (1838-1907) said : " It is true that the intelUgence exists in all parts of the cortex, or, rather, in all parts of the brain, but I hold that abstract thought needs a separate organ, and seek for it in the frontal lobes." He claims to have observed that dogs whom he deprived of the frontal area forgot all they had learned and could not learn anything new. FERRIER observed that "after removal or destruction by the cautery of th» antero-frontal lobes, the animals retain their appetites and instincts, and are capable of exhibiting emotional feeling. They have lost, however, the faculty of attentive and intelligent observation." He locates the centres of reflection and attention in the frontal lobes. BIANCHi found after destruction of the frontal lobes in dogs and monkeys that the curiosity to observe, which is so marked in monke\^, is lost ; that they are not able to receive new impressions, or to remember or reflect on the old ; and that since they can no longer criticise they become timid and easily excited. The frontal lobes appeared to him not only centres of perception and reflection, but also co- ordination centres of the rest of the brain. He said : " The animals remain friendly, they still caress or show affection. They can get into wild excitement. They show fear more readily. They become cautious, but cannot avoid accidents ; these strike terror into them. They eat ■with reckless avidity. They are duller and sleepy. The physiognomy is stupid ; the expression cruel. They show no grate- fulness. They cannot adapt themselves to new surroundings, neither learn any- thing new, nor regain wiiat they have forgotten." His hypothesis is " that the frontal lobes are the seat of co-ordination and fusion of the incoming and outgoing products of the several sensory and motor areas of the cortex. The frontal lobes sum up into series the products of the sensory-motor regions, as well as the emotive states which accompany all the perceptions, the fusion whereof constitutes what has been termed the psychical tone of the individual. Removal of the frontal lobes does not so much interfere with the perceptions taken singly as it does disaggregate the personahty, and incapacitate for synthetising groups of representations. The actual impressions which serve to revive those groups thus succeed one another disconnectedly under the influence of fortuitous external stimuli, and disappear without giving rise to associational processes in varied and recurrent succession. With the organ for the physiological fusion which forms the basis of association disappear also the physical conditions underlying reminiscence, judgment, and discrimination, as is well shown in mutilated animals." The destruction of the frontal lobes, according to Bianchi, entails the loss of the anatomical and physio- logical basis upon which judgment and the reasoning faculties are reared. The monkeys operated upon by Ferrier lost the power of psychical concentration and attention. According to Bianchi, the animals lost much more, namely, the power of recalling the images of previous sensations in commemorative form, and the power of associating these images in abstract synthesis. He observed the same symptoms in the human subject in cases of tumour affecting the anterior portion of the brain. Hitzig's, Fenier's, and Bianchi's localisation of the intellect possesses a special interest owing to the fact that it contains a negation, implied if not expressed, which INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 93 is more important than the afi&rmation : Whilst they assign an intellectual function to the pre-frontal lobes, they deny it to the other regions of the cortex. ANTON agrees with Bianchi ; and COLELLA, too, considers, as a result of his experiments, that the pre-frontal lobes are the seat of the highest psychical functions. S. J. FRANZ (" Archives of Psychology," 1907), after training monkeys and cats, destroyed their frontal lobes, when he found that all freshly acquired habits and knowledge were lost ; but if any other part of the brain was destroyed they were not lost. This loss cannot be ascribed to shock, loss of blood, or the anaesthetic, for in the destruction of the other parts they are just the same. If one lobe was destroyed, the intellectual associations and actions were not lost but retarded. The emotions and passions were manifested the same as before. LUSSANA (1820-1898) extirpated the first and second frontal convolutions and the orbital lobes of dogs and observed that such animals no longer recognised their master, nor the street or house they lived in. Destruction of any other area of the brain still preserved these memories. This observation will be confirmed by me by a large number of cases of lesions of these parts in man. Pathological observations also confirm this localisation. It is universally known that in senile dementia and dementia of any kind, including dementia paralytica or general paralysis of the insane, the greatest atrophy occurs in the frontal lobes. Physiologists not being pathologists, many of them have taken no note of tliis. Moreover, the convolutions of the frontal lobes in idiots and imbeciles are deficient and there is a want of development of the nerve-cells — as we should expect if our theory is true. MEYNERT (" Wiener Medizinische Presso," 1886) observed that " all forms of dementia, including senile dementia and dementia paralytica, are due to brain atrophy affecting the frontal lobes, whose weight is much reduced, whereas the other lobes are hardly at all involved." HITZIG pointed out already, in 1874, that the ruin which progressive paral3rsis — that implacable destroyer of the intellect — produces, is pre-eminently in the cortex of the frontal lobes. FERR lER observed in lesions of the frontal lobes " inability to fix the attention," and he says : " The frequent association of idiocy with defect of the frontal lobes is a generally recognised fact." CARL VOGT (1817-1895) found : " The brain formation of microcephalous idiots does not depend on an arrest of development of the brain equally all over, but chiefly of the frontal lobes." B. SACHS found : " Large porencephalic defects in the parietal areas are com- patible with a tolerable high mental development, whereas a defective development of the frontal lobes leads to complete idiocy even though the remainder of the hemispheres has attained to normal growth." JOSEPH SHAW BOLTON has shown that in dementia the frontal cortex, especially the pre-frontal area, is greatly degenerated, and that in idiots the degrees of mental deficiency correspond with the lack of development of the same region, while the remainder of the brain may be normal. " The pre-frontal region is the region of the cerebrum which is concerned with the performance of the highest co-ordinating and associational processes of mind." Bolton — in opposition to A. W. Campbell — has found that the pre-frontal area of the brain is of extremely complex structure and of finer architecture than any other part of the brain. " It is the last region of the cortex cerebri to develop ; it possesses the highest associational functions, and is the first to undergo retrogression. The greatest amount of wasting in dementia occurs in the pre-frontal region. In cases of amentia there is under-development of the pre-frontal region and a more or less marked simplicity of the convolutional pattern. The high-grade ament is a man who is required to do a man's work with a child's brain." (Journal of Mental Science, 1906.) CHARLES K. MILLS, late Professor of Neurology in the University of Penn- sylvania, said: "The region of the brain in which focal,i lesions have produced persistent psychic symptoms has been the pre-frontal lobe. If these lesions are 94 THE MENTAL FUNCTIONS OF THE BRAIN both extensive and deep-seated, disorders of memory, will, attention, comparison, and judgment may be present." And again : " Lesions of the pre-frontal lobe, although this is one of the so-called latent districts of the brain, have in a large percentage of the carefully studied cases shown distinctive manifestations. The symptoms are largely psychical, and unfortunately the physician is not usually well trained to study such phenomena. Mental disturbances of a peculiar character occur, such as mental slowness and uncertainty, want of attention and control, and impairment of judgment and reason ; closely studied, the inhibitory influence of the brain both upon psychical and physical action is found to be diminished." G. ANTON ("NeurologischesCentralblatt," 1900) gave the following description'of lesions of the frontal lobes : " Injury to one frontal lobe has as a consequence that the intellectual functions can be carried on only with greater exertion. The memory and judgment are weakened, and continued attention is rendered difficult. If the disease extends to the other frontal lobe as well, then we have sudden and hopeless dementia." F. DURANTE said that lesions of the frontal lobes are always followed by in- tellectual changes, and that the frontal, especially the pre-frontal, region is the seat of the highest mental powers. P. SCHUSTER ("Mental Changes Accompanying Brain Tumours," 1902) stated that melancholia and paranoia are hardly ever observed in lesions of the frontal lobes, but mania and dementia are. P. FLECHSiG (" Gehirn und Seele," 1896) located in the frontal lobes the anterior association centre of attention, reflection, inhibition. It is concerned with abstract concepts and other complex intellectual processes. He observed the following changes taking place in lesions of the frontal lobes : (i) active apperception ceases ; (2) logical reasoning becomes defective ; (3) loss of ethical and aesthetical judgment ; (4) exaltation ; (5) loss of self-control. Richet, De Bayer, Duret, Grasset, P. W. MacDonald, and many others expressed similar opinions as to the functions of the pre-frontal lobes. The majority of physiologists have ignored Wundt's distinction between perception and apperception — the centres for which he located in the frontal lobes — and persist in placing these centres in the sensory regions, visual, auditory, etc. We shall deal with these centres in this chapter, and will mention for the present only that from the evidence which we are about to submit it does appear that they are related to the lowest parts of the frontal lobes, viz., the inferior parts of the three frontal con- volutions, the orbital convolutions, and perhaps the small convolutions within the fissure of Sylvius. We shall quote cases which demonstrate that destruction Of these parts causes loss of definite perceptive powers and memories. We also find that when the frontal lobes are destroyed by inj ury or disease the processes of judgment and reason are diminished, there is an inabihty to fix the attention, to follow a continuous train of thought, or to conduct intellectual pro- cesses, ultimately ending in complete dementia. We find, moreover, that in such men the struggle between the lower instincts and ethical feelings is diminished or does not exist any longer, and instead of a rational man, we see a creature given over to the satisfaction of his lower desires. Such is the case in all forms of lesions of the frontal lobes, and it does not occur in lesions of other parts of the brain. Hyperaemia of the frontal lobes of the brain, or any other irritating pathological condition, causes an increased activity of the mental processes of perception, association, and reproduction. The patient forms numerous plans and projects, has a rapid flow of ideas, and through stimulation of the speech centre is loquacious, but his stream of talk and ideas is perfectly coherent ; it is only in the advanced stage that he may become incoherent. The other lobes of the brain being un- affected and deprived of the control of the intellect, manifestations of the natural feelings and animal spirits occur. There is a pecuhar hilarity and tendency to jest, and there may be actual exaltation. The patient is free from hallucinations and delusions, knows his surroundings, and many men fail to recognise in him anything INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 95 abnormal. This state of mind is called manie by the Germans and French, and is not the same as the English " mania," by which usually a furious state is meant, described by the Germans as Tobsucht. In the hypomaniac, as the patient suffering from manie is sometimes called, all the psychical processes take place with unwonted alacrity and exuberance, creating in the mind of the patient joy, satisfaction, and self-confidence. There is euphoria, a happy state, and moria, a jocular state of mind. The good spirits of the hypomaniac seem, excepting for occasional slight abatement, to be inexhaustible ; they almost never leave him ; they make dangers invisible, misfortune Ught, life easy, and its struggles pleasant. If some incident in a patient whose frontal lobes are excited (as in manie) arouses ill-humour, it is not for long, and certainly does not increase to blind fury (as in Tobsucht) ; but the two forms of mania can occur together, and usually the former lapses into the latter. Temporary depression may precede the maniacal attack from a vague conscious- ness of an approaching mental disturbance. A temporary state of depression may also follow the attack in consequence of the exhaustion after the excessive mental and motor activity, and partly from the recollection of the mental illness and a reflection on the consequences of the many foolish things said and done. Such depression is under the circumstances perfectly natural, and should not be mistaken for " melanchoha." EUPHORIA Both in functional and organic lesions of the frontal lobes there is one charac- teristic that is missing in lesions of any other part of the brain, and therefore diagnostic, that is, the patient has no anxiety as to his condition ; on the contrary, frequently there is a sense of well-being and general optimism — a mental condition called euphoria is present, while depressio n is most common in lesions of the parietal and occipital lobes. While the parietal lobes, as will be shown in the next chapter, seem to be in special relation to the sympathetic nervous system, the frontal lobes appear to be specially connected with the cerebro-spinal nerves, and consequently their stimula- tion gives rise to unrestrained, spontaneous muscular activity, with a feeling of joy, as seen in laughter and play. Certain it is that lesions of the frontal lobes are more often accompanied by euphoria, and lesions of the parietal lobes by melancholia, and that in the one there is an excess, and in the other a diminution of mental and muscular activity. For exceptions, see next chapter. The mental processes of perception, association, and reproduction are stimulated, and there is emotional exaltation ; hence the patient exhibits a rapid flow of ideas, coupled with an unmeaning gaiety and increased motor activity. The perfect health and general well-being of these patients renders them joyous, talkative, satisfied with themselves and content with others. Natural dispositions such as hope, pride, and ambition, in addition to the imagination, are stimulated to excess as the disease progresses ; delusions of grandeur and of vanity, of increased wealth, power, and importance may develop, followed by confusion and disorientation, until all the ideas are affected and chronic dementia is the result. The patient, as has been mentioned, may get angry when offended, or on receiving ill-treatment, but his irascibility does not last. It is over when the cause is with- drawn. Similarly his motor excitement is of the joyful type and not of the de- structive furious rage order. If damage is done it is good-humouredly. This distinguishes the hypomaniac from the " acute " furious maniac. The patient's stream of talk in the early stage is perfectly coherent, as we have already pointed out, but it is not always refined owing to the loss of inhibitory power over the propensities ; hence the patient may show erotic passion or he may steal 96 THE MENTAL FUNCTIONS OF THE BRAIN if there is an inclination to it normally, but even then it is not done from a blind impulse but from a desire to do mischief for the fun of the thing. This desire to do mischief for his or his companions' amusement may prove troublesome, but is easily controlled by judicious management, and need not be regarded as dangerous. The euphoria of frontal lesions is not based on delusions but is absolutely free from any motive. It is also in sad contrast to the seriousness of the patient's condition. Frequently there is to be observed an inclination to witticism, joking, punning — a state called moria — which also does not occur in lesions of other parts of the brain. P. SCHUSTER (" Psychische Storungen bei Him-tumoren ") found irascibility a symptom in frontal tumours ; but he included any and every case he could find in medical literature, and thus included also epileptics who developed frontal tumours. But irascibility is a common symptom accompanying epilepsy and not diagnostic of frontal tumours. Schuster included even alcoholics suffering from frontal tumours as showing irascibility. M. JASTROWITZ ("Deutsche Medizinische Wochenschrift," 1888) noticed in tumours of the frontal lobes a peculiarly cheerful excitement — hilarity and witti- cism — which is retained sometimes even on the operating table until the application of the anaesthetic. He observed also that the patient is given to grimaces. H. OPPENHEIM (" ChariteAnnalen," vol. x., and " Archiv fiirPsychiatrie," 1890) gave quite a number of cases of frontal tumour with abnormal witticism and humorous remarks. L. BRUNS (" Deutsche Medizinische Wochenschrift," 1892) observed play with words — punning — and witticism. A. RICHTER (" AUg. Zeitschrift f. Psychiatrie," 1883) and KNdRLEiN observed grimaces. Sir WM. GOWERS (" Textbook on Nervous Diseases ") and M. BERNHARDT (" On Brain Tumours ") noticed childishness and childish actions. J. B. F. BAILLARGER (1809-1890), " Annales Medico-Psychologiques," 1881), published six cases of " ambitious delirium," i.e., mental exaltation, with focal lesions in the frontal lobes. The dehrium may continue for six months or longer, he said, without lesions of chronic peren cephalitis. Prof. COLIN, of Val-de-Gr&ce, published in 1878 a paper on " General Paralysis, in which he declared that a lesion of the frontal lobes of the brain may become the starting-point of general paralysis, by extension of what is at first a focal area. MEYNERT held that in mental derangements in which exaltation forms a prom- inent symptom the frontal lobe is the affected part, not so in derangements in which depression is the leading characteristic. (" Erkrankungen des Vorderhirns," 1884.) F. OBERN lER considered exaltation to be one of the symptoms of tumours of the frontal lobes. A. VOISIN (" Traite de la Paralysie Generales des Alienes," Paris, 1879) assumed a centre of exaltation — centre de grandeur — in the brain. EXAMPLES OF EUPHORIA AND EXALTATION CASES OF FRONTAL TUMOURS Case of Frontal Tumour with Euphoria. THOMAS LYLE ("Journal of Mental Science," 1880) : T. H., a boatman, " keeps in the very best of spirits. When asked how he is, says he feels ' very well,' repeating the words ' very well.' He sings occasionally, and talks a good deal of the fine boats he possesses, and addresses strangers by some famihar name, such as ' Joe ' ; labours under the delusion of mistaken identity, and holds out his hand to shake hands with strangers, beUeving he has known them all his life. Takes his food well and enjoys it. Generally very happy and .con- tented. No history or symptoms of syphihs." Post mortem, a tumour was found occupying the greater part of the right frontal lobe. INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 97 Case of Frontal Tumour with Euphoria. F. X. DERCUM (" Journal of Nervous and Mental Diseases," 1910) : M. S., age thirty-two, merchant. " The patient's answers to questions are somewhat variable and he is at times distinctly confused. He smiles readily and seems quietly pleased. He manifests no anxiety as to his condition. He asks no questions." A huge tumour was removed from the frontal lobe. Patient died shortly afterwards. Case of Frontal Tumour — Euphoria — Moria — Disturbances of Memory. D. CAMPBELL (Altona), " Monatsschrif t fiir Psychiatric u. Neurologic," 1910 : Patient, thirty-seven years old, conscious of his surroundings, gives a correct account of his past history, but confabulates when interrogated about recent events, has no sense of time, does not know recent dates, is indifferent as to his condition, cheerful, witty, easily irritated but quiet when left alone. Post mortem, tumour was found involving both frontal lobes. Case of Frontal Tumour — Euphoria and Loss of Memory. CASTAN and LEJONNE (" Revue Neurologique," 1901) : A woman, age thirty-three, was admitted into the Salpetriere with optic neuritis, Jacksonian epilepsy, and a pecuhar psychical disturbance. Suffering at the com- mencement of her illness from apathy and torpor, probably due to cerebral com- pression, she now passed into a state of high spirits, looking happy and smiling when spoken to, complaining no longer, and showing signs of good humour and good appetite. Her intelligence seemed a little blunted, and she laughed at almost everything which was said to her, and exhibited little initiative or volition of her own. Her recollection of things said to her was poor. Her habits remained neat and clean, and she was free from dementia. A somnolent state succeeded the euphoria, lasting three months. The necropsy revealed a large cystic tumour involving the posterior two-thirds of the ascending frontal convolution. Case of Frontal Tumour with Euphoria, Moria, Loss of Appreciation of Time and Loss of Moral Sense. F. X. DERCUM (" Journal of Neivous and Mental Diseases," 1908) : D. P., age fifty, clergyman ; family history and previous history good. Only signs he noticed was failing sight and headache. His friends, however, observed the following changes : " He appears to be easily pleased and is of an easy disposition. He was at one time exceedingly active and interested in his clerical duties, but now is indifferent to his duties. He never worries about anything. He used to be very conscientious, but now is apt to take everything as a joke. He is never serious. Formerly he was very punctilious, but now he is careless in regard to keeping his appointments and indifferent as to beginning his services at the right time. He has done various erratic things, such as visiting his friends and forgetting altogether the proprieties as regards the length of his stay. He would remain all day and once stayed even for weeks. This conduct contrasted strongly with his former habits." Later on he deteriorated morally. When asked to undress, it was found he had not a single undergarment upon his person, and when asked to explain why he had dressed himself this way, he did not seem to realise that he had done anything unusual. Post mortem, an enormous tumour was found involving both frontal lobes to about an equal extent. These lobes had suffered extensively from com- pression and loss of the white substance ; while the convolutions, especially the anterior and orbital portions of the first and second frontals on either side, had been much thinned. The tumour upon microscopical examination proved to be a sarcoma. Case of Frontal Tumour with Euphoria and Moria. W. CAMPBELL (" Monatsschrift f. Psychiatric u. Neurologic," 1910) : Man, age thirty-seven, suffering from tumour involving both frontal lobes, the Vol. ii.] H 98 THE MENTAL FUNCTIONS OF THE BRAIN right almost completely destroyed. The symptoms were : bad memory for recent events, confabulation, moria, indolence, sleepiness, and violent headache. He had no hallucinations and was not demented. He went blind. Case of Frontal Tumour with Exaltation. V. MAGNAN (" Revue Mensuelle de Medecine et de Chirurgie," 1879) : reports a case of exaltation in which post mortem a tumour was found in the ascending frontal convolution about its middle third. Case of Frontal Tumour with Exaltation and Excessive Hopefulness. F. LALLEMAND (" Recherches Anat.-pathologiques sur I'Encephale ") : Jean Bailly, age sixty, after some ill-treatment by soldiers, had several paralytic seizures which passed off. Coincidently his character changed. He developed an excessive " hopefulness," a blind belief in obtaining a considerable fortune, and planned great enterprises. One characteristic deformity was observed : his mouth was drawn up on the right side. Post mortem, a tumour was found, the size of a large egg, on the posterior surface of the right frontal lobe. Tumour of Frontal Convolution with Exaltation. SIEMENS, " Berhner Klinische Wochenschrift," 1888. Frontal Tumour with Exaltation, Optimism, Dementia. J. B. F. BAILLARGER, " Annales Medico-psychologiques," 1881. THOMAS LYLE, ibidem. 1883. TARGOULA, ibidem, 1890. OTHER LESIONS Cases of Frontal Lesion with Euphoria. ALFRED GORDON (" Journal of American Medical Association," 1907) : J. M. H., age thirty-four, "when asked where he was, repUed 'in Paradise.' Every act and word expressed enchantment. He would joke with strangers. He expressed pleasure at anything offered him. Any article of food tasted delicious." Post mortem was found haemorrhage in left frontal lobe. L. PIQU6 (" Soc. de Chirurgie,") 1910 : H., age fifteen, fell from a train, sustaining a comminuted fracture of right frontal bone. Three months later developed excessive gaiety, laughing incessantly. Case of Exaltation with Loss of Moral Sense. CHARLES W. BURR (" Journal of American Medical Association," 1907) : A woodworker, age thirty-five, had his left frontal bone fractured in a railway accident. In a few weeks he became grandiose, careless as to money, and obscene. Burr mentions several other cases of apparently focal lesions, but gives no details as to their locality. Cases of Frontal Lesion with Exaltation. MARANDON DE MONTYEL ("Annales Medico-psychologiques," 1877) : In a patient suffering from delire des grandeurs there was found post mortem in- flammatory adhesions of the meninges to the left ascending frontal convolution. KRAFFT-EBING (" Traumatic Insanity," Erlangen, i{ G. B., age twenty-nine, farmer, fell from his carriage on the left side of the vault of the skull. He developed mania of exaltation. Death six years after the accident, when two sequestrae were found in left ascending frontal convolution. L. MARCHAND ("Soc. Anat.," 1905) : Patient hit by a stone on the head when four years old. Exaltation deUrium set in at fifteenth year and continued till death at age of sixty-three. P. M. soften- ing of left ascending frontal convolution. INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 99 MENDEL (quoted by Paul Guder, " Geistesstorungen nach Kopfverletzungen," Man, thirty-six years old, good history, was hit with a pistol on top of head. Scar two and a half inches long at sagittal suture parallel with coronal suture. Paresis of arm, aphasia, exaltation. Post mortem, the cranium was found thickened in the region mentioned with exostoses ; blood-extravasation with pseudo-membrane internally. Case of Frontal Lesion with Exaltation and Euphoria. V. MAGNAN (" Revue Mensuelle de Medecine et de Chirurgie," 1878) : The patient, a butcher, age fifty, showed, a few days before admission, excessive activity in making exalted plans, and was possessed by an abnormal cheerfulness and optimism. Post mortem was found a symmetrical lesion in the middle 3-5th of each ascending frontal convolution, the active congestion extending to half the middle and lower frontal convolutions, EXAMPLES OF SURGICAL TREATMENT Case of Frontal Tumour with Loss of Induction and Deduction, and Recovery after Surgical Operation. This case should be compared with those of lesions in other parts of the frontal lobes, especially with that of Abel and Colman (p. 108), which, it will be seen, produce no loss of judgment and reason, but intellectual deficiencies of another kind. WILLIAM ELDER and ALEXANDER MILES (" Lancet," 1902) : Patient, a man, age forty-seven, had a tumour of the left pre-frontal lobe exactly under the frontal eminence, which was swollen. As regards the afiectio 1 of his memory, it appeared to be not so much a blotting-out of his past impressions as a want of power of associating memories, of comparing and contrasting them. Loss of power of forming a judgment about anything and loss of attention were prominent symptoms of his mental condition. He could not compare or contrast two things or ideas. His individual memories seemed all right. He recognised objects and friends. His emotional condition was another prominent symptom in his case. He lost the sense of modesty and shame. There was evidently loss of inhibition. The skuU was trephined, the tumour was removed, and the patient's symptoms rapidly disappeared. Case of Frontal Injury with Symptoms of Exaltation, and Recovery after Surgical Operation. BARTON and GAYTON (" British Medical Journal." 1891) : A woman, age thirty-nine, married, no family. There was a history of a blow on the head received whilst running upstairs, when she knocked her head against the top of the doorway. This spot, which was the seat of very great pain and headache, was selected for the operation, namely, one inch to the right of the middle line and one inch behind the coronal suture. Patient had exalted ideas of wealth, delusions as to possessing carriages and horses, etc. There were no convulsions previous to the operation, but there were two afterwards. A fortnight later she began to improve, and from that time made a steady recovery. The delusions and headache were both cured. Before the operation she wrote badly and incoherently ; after the operation her handwriting improved, and she wrote a reasonable letter. She was discharged. Case of Surgical Treatment of General Paralysis of the Insane. T. CLAYE SHAW (" British Medical Journal," 1891) : A man, age thirty-six, a packer at the Army and Navy Stores, had, when admitted, grandiose delusions, and was impaired in both gait and speech. He was TOO THE MENTAL FUNCTIONS OF THE BRAIN trephined by Mr. Harrison Cripps. The operation was carried out on the right side of the head about the middle of the post-central convolution, and consisted of making two one-inch trephine holes, about two inches apart, and removing the intermediate bone. There was considerable bulging of the tissues beneath the opening, indicating pressure. The underlying dura mater was removed, and the pia excised. A considerable quantity of fluid drained away, and the opening was then closed by replacement of the skin. Mental improvement followed, the intellect was clearer, patient became coherent, and had no delusions. He died suddenly in convulsions. At the post-mortem examination it was found that the trephine hole was completely filled up by a tough fibrous membrane. On the under-surface this membrane was adherent to about the size of a shilling to the cortex of the middle of the ascending frontal convolution. Another similar case by the same author {ibidem, 1891). THE FRONTAL LOBES AS CENTRES OF INHIBITION. THE MORAL SENSE Let me lay stress on the fact that the frontal lobes act as centres for inhibition — that is to say, they enable us to exercise control over our feelings and impulses. In injury or disease of the frontal lobes, therefore, will the intellect be affected, or some elements of it ; but more manifest still will be the loss of inhibition over the natural dispositions of the man, in consequence of which they will be manifested in a much exaggerated manner. This accounts for the inaccurate statement so often made that frontal lesions may be accompanied by almost any symptom — irascibility, depression, suspicion, etc. These manifestations are not the symptoms ; the only diagnostic symptom is the loss of control over the natural tendencies. The frontal lobes, containing the centres for the reasoning processes, act as an inhibitory apparatus against the lower and more instinctive innate impulses. The more developed the frontal lobes are, the more they overbalance the rest of the brain — the greater the tendency to subordinate the instincts of self-preservation and the egoistic feehngs to the intellect, and to act as check on the animal pro- pensities — the more moral the man. If this inhibition becomes weakened or totally lost, then we see the disordered predominance of the instincts and impulses. These being out of control may lead the passionate man to immoral actions, and the man with strong anti-social impulses to criminal deeds. It is the highly developed intellect of man which changes the innate animal propensities into glorious faculties. Thus the animal desire of propagating the species is transformed in man to moral love ; the love of female animals for their ofispring, provided by Nature to preserve their young, becomes in women the amiable virtue which inspires their tenderness for their children ; the attachment of animals changes in man to friendship ; their sensibility to caresses changes into ambition and a sentiment of honour ; the instinctive building of nests by birds and of huts by beavers is at the root of man's nobler dwellings, of his temples and palaces. It is the frontal brain with its connecting fibres to all the remainder of the cortex to which this difference is due. The larger the anterior lobes in proportion to the rest of the brain, the more refined will be the expression of the emotions, and even of the passions, of man, and the greater control will he be able to exert over them. Let the frontal lobes be arrested in development, or affected by disease, and man descends to the animal stage. From this one might wrongly conclude that the development of the moral sense I is in proportion to the development of the intellect. But this is not so, for as everyone knows, there axe moral idiots as well as intellectual idiots — men bom with fair intellect but with an entire absence of the higher moral sentiments, entirely destitute of moral feeUng. They are as insensible to the moral relations of fife, as deficient in this regard as a person colour-blind is to certain colours, or as one without INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN loi ear for music is to the finest harmonies of sound. If caught in an immoral or criminal act, they show no repentance. They may perhaps feel and dread the material consequences of crime, but they are deficient in the feeling of moral guilt. They are not lacking in intelligence ; but their intellect is put to bad use. This view may go against the convictions of some people ; there are magistrates and judges who deny such an assumption. But it is not alone on the basis of the evidence I am about to quote that I assert that moral idiocy is due to a deficiency of a par- ticular portion of brain, but my assertion is based also on evidence, which I am not at liberty to publish — namely, that contained in my case-books, of persons, des- cendants of well-known families, whose respectabUity is of repute, whose careers .1 have been able to watch from infancy and of whose convictions for various crimes I have kept records. Still, I agree with those who hold that there are no definite centres in the brain lor the manifestation of the moral sentiments. But there are centres for adaptation and self-control, and that is what morality amounts to. These centres appear to be in the posterior part of the frontal lobes, which seem to act as a check to all the other centres. The actual locality is of no consequence at present, so long as it is recog- nised that the moral sentiments may be lost in lesions of some portion of the brain. If a blow on the head can cause such circumscribed mental changes that only the morality of the man deteriorates, while he remains in all other respects as before, it shows that morality or immorality — that is, the tendency to one or the other — depends on brain conditions. And if this be admitted, then we are also justified in assuming that the moral tendencies are subject to the laws of heredity, though environmental influences and education will always? discount to a large extent the forces of heredity. The so-called moral sense is of course highly complex ; originating in the social sentiments, largely guided by the approbation of our fellow-men, ruled by reason, self-interest, religious feeling, and experience of the more remote consequences of our actions. But in the course of evolution it has become part of the mental organisation, varying in degree in different people and dependent no longer so much on the approbation of others as on the approbation of self ; in other words, it has become — conscience. That it is not the product of a purely reflective faculty we see in children from the earliest age. Some have it strongly without teaching or example ; others have it sparingly, and need the most assiduous care to develop it. F. L. GOLTZ (1834-1902), although an opponent of the localisation theory, was a very accurate observer. He admitted that when the frontal lobes are destroyed the inhibitory power over the emotions and propensities is lost and such an animal changes its character for worse. His dogs that were very docile and good-tempered became, after removal of the' frontal part of their brain, easily excited, irascible, made much noise, and were constantly disposed to fighting. In fact, it seems Goltz produced in his dogs symptoms similar to mania in man. (" Die Verrich- tungen des Grosshirns," Bonn, 1881.) J. LOEB found the same as Goltz. PAUL FLECHSIG (1847-1904) said : "The result of the action of physical im- pulses upon the cortex is a struggle between sensory impulses and reason. As soon as the power of the mental centres is paralysed, the impulses are deprived of mental control, and passion reigns unbridled." He found in lesions of the frontal associa- tion centres that patients " could not distinguish truth from untruth, imagined events from experienced events, possible things from impossible. Ethical and aesthetical judgment diminishes, prudence in the manifestation of the propensities is lost, self-control is lost. Finally idiocy results with loss of personal identity." CAMPBELL (" Journal of Mental Science," 1904) declared — on histological evidence supplied by LEONORE WELT, and emphasised by v. MONAKOW— that " de- struction of what one may call the middle part of the frontal lobe gives rise to various disturbances of the moral faculty." L. F. BARKER, Professor of Anatomy and Pathology in John Hopkins Uni- versity, said : "When the intellectual centres are paralysed, there often results I02 THE MENTAL FUNCTIONS OF THE BRAIN most marked disorganisation of the mental processes, and most serious alterations in the character of the individual. The struggle between the lower instincts and the ethical feelings may cease, and instead of a rational man we see a creature given over entirely to the satisfaction of his lower desires." W. C. SULLIVAN, late Medical Officer H.M. Prison, Holloway (" Lancet," 191 1), records two cases of frontal tumour in prisoners and accounted for their crime by the loss of control over the propensities. He ascertained the cause of death in prisoners to be brain tumour in four per cent, of the total mortality, a rather high proportion when it is borne in mind that cases of this disease with distinct physical or mental impairment would not be likely to be sent to prison, or, if sent, would not be detained . ALLEN STARR, who has studied the mental disturbances following disease of the frontal lobes, gave the summary of twenty-three cases in the American Journal of Medical Sciences, 1894. He laid great stress on the frontal brain as an inhibitory organ. He regarded it therefore as the seat of judgment and reason, the highest psychical manifestations. Through the loss of self-control, he said, the attention can no longer be fixed, and the patient can no longer follow the sequence of his ideas. He regarded the loss of attention as important. He said : " The form of mental disturbance in lesions of the frontal region does not conform to any type of insanity. It is rather to be described as a loss of self-control and a subsequent change of character. This action of control implies a recognition of the importance of an act in connection with other acts — in a word, it involves judgment and reason, the highest mental qualities. It seems probable that the processes involved in judgment and reason have for their physical basis the frontal lobes ; if so, the total destruction of these lobes would reduce man to the state of an idiot, while[their partial destruction would be manifested b}'^ errors of judgment and reason of a striking character. One of the first manifestations would be a lack of that self-control which is the constant accompaniment of mental action, and which would be shown by an inability to fix the attention, to follow a continuous train of thought, or to conduct intellectual processes. It is this very symptom that was present in one half of the cases col- lected. It occurred in all forms of lesions — from injury by foreign bodies, from destruction by abscess, from compression by softening due to the pressure of tumours — and therefore cannot be ascribed to any one form of disease. It did not occur in lesions of other parts of the brain." EXAMPLES OF THE LOSS OF MORAL SENSE That the frontal lobes represent the higher nature of man is shown in cases of their destruction — or rather destruction of certain parts of the frontal lobes — when all the stock of inherited and acquired sentiments — in fact, man's moral nature — seems to disappear on account of the loss of the power of inhibition. Everyone knows of the classical " Crowbar Case," recorded by Dr. HARLOW. It is so typical that it cannot be too often quoted. But it has been misrepresented in many of our text-books as being typical evidence that loss of brain substance may occur without any mental change, simply because moral sentiments are not sup- posed to be dependent on brain matter. In his work on "The Functions of the Brain," 1876, Sir DAVID FERRIER referred to the case as illustrating the fact that disease or inj ury to the frontal region in one hemisphere is not followed by any appreciable mental symptoms. However, in his later work, " The Locahsation of Cerebral Disease," 1878, he furnished a detailed account of it, proving the contrary. Nevertheless, in Kirkes's " Handbook of Physiology," sixteenth edition, 1900, the crowbar case is still misrepresented, it being said that " no noteworthy symptoms were observed " in the patient " during the rest of his life," indeed, he " returned to his work as overseer to the mine." This is not true, and I am glad to see that in more recent editions the case has been left out altogether. Another author quotes the case as showing that the patient " lost nothing of mental power or sagacity and was entirely clear in all his mental processes." The foUomng is the actual history : INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 103 " While Phineas P. Gage, age twenty-five, was engaged tamping a blasting charge in a rock with a pointed iron bar, three feet seven inches in length, one inch and a quarter in diameter, and weighing thirteen and a quarter pounds, the charge suddenly exploded. The iron bar, propelled with its pointed end first, entered at the left angle of the patient's jaw, and passed clean through the top of his head, near the sagittal suture in the frontal region, and was picked up at some distance covered with blood and brains. The patient was for the moment stunned, but within an hour after the accident he was able to walk up a long flight of stairs and give the surgeon an intelligible account of the injury he had sustained. His life was naturally for a long time despaired of, but he ultimately recovered, and lived twelve years and a half afterwards." This is what Dr. Harlow says of his mental condition during that period : " His contractors, who regarded him as the most efficient and capable foreman in their employ previous to his injury, considered the change in his mind so marked that they would not give him his place again. The equilibrium or balance, so to speak, between the intellectual faculties and animal propensities seems to have been destroyed. He is fitful, irreverent, indulging at times in the grossest profanity (which was previously not his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating ; devising many plans of future operation, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the criminal passions of a strong man. Previous to his injury, though untrained in the schools, he possessed a well-balanced mind, and was looked upon by those who knew him as a shrewd, smart business man, very energetic and persistent in executing all his plans of operation. In this regard, his mind was radically changed, so decidedly, that his friends and acquaintances said he was ' no longer Gage.' " Gage became " very childish." He died twelve and a half years after the accident in epileptic convulsions. The base of the frontal bone was found fractured. Case of Frontal Injury followed by Moral Insanity. SIR ROBERT ARMSTRONG-JONES (" Archives of Neurology," 1907) : X. Y., age twenty-six, was admitted to Claybury Asylum from prison. The family history was singularly free from insanity and drink. The patient was in good health and condition, and the organ apparently normal. Traumatism was the assigned cause of insanity, patient having fallen forty feet from a lift and fractured his skull in the pre-frontal region. The forehead showed a linear scar 6 centimetres long, with obvious depression of the right frontal bone. Patient was unconscious for several days after the accident, and there was some loss of brain Substance. Six months later some portions of dead bone were removed at St. Bartholomew's Hospital, and after two or three years of medical treatment he was pensioned as unfit for further work in Woolwich Arsenal. Before the accident, patient was bright, energetic, honest and trustworthy, a hfe-abstainer, and much respected. After the accident there was complete metamorphosis ; his career became a record of moral obhquity and mental perversion. He was idle, irritable, threatening and violent ; he was three times convicted of indecent behaviour, the last time being detained during His Majesty's pleasure, and after being in prison a month was remo.ved to Claybury. Case of Frontal Tumour with Moral Degradation, and Recovery after Surgical Operation. FRANCESCO DURANTE (Rome), "British Medical Journal," 1902) : G. B., age forty-six, a housemaid, was admitted in March, 1896. She had been operated on in May, 1884, for fibrosarcoma of the dura mater compressing the left frontal lobe. " The patient on both the first and second occasion had contracted the habit of excessive license of language, to such an extent as to make highly improper remarks, and when reproved she not rarely broke into oaths. When she presented herself to me for the second operation, her relatives informed me that for several months she had manifested a peculiar perversion of the moral sense, shown I04 THE MENTAL FUNCTIONS OF THE BRAIN not merely by the use of improper expressions, but by actions void of all decency and absolutely unbecoming in an honest woman." Durante diagnosed a recurrent fibrosarcoma of the left frontal lobe, and an operation found the same adherent to the falx cerebri and extending downwards to the crista galli. He removed the tumour, and the result was a complete cure of all the symptoms. Case of Brain Lesion at posterior end of superior frontal convolution followed by Moral Insanity. L. CANALI, " Bulletin de la Societe de Medecine Mentale," 1881. FRONTAL LESIONS WITH RELIGIOUS MANIA The frontal lobes containing the centres which enable us to exercise control over our natural dispositions, it follows that men by nature religious, when they suffer from frontal lesions, become more intensely religious in their thoughts and conduct. The following are examples of religious mania from lesions of the frontal lobes. Case of Frontal Lesion with Religious Mania. JAMES GEORGE DAVEY (" Zoist," vol. i.) : E. M., a woman, age sixty-four, suffered from religious insanity, the first sign of which was evinced by a love for theological disputes, which eventually became so excessive that she disturbed religious services by calling the minister to order for the opinions he expressed. She subsequently regarded herself as an apostle, and declared she was an instrument in the hands of the Almighty, with which it was His intention to effect extraordinary and great good. Sacred music sent her into ecstasy, and she sometimes fell into a paroxysm during the service at the asylum chapel. Post mortem the brain and its membranes were found healthy, with the exception of a circumscribed part in the superior frontal convolution corresponding to the anterior fontanelle, where the tissues were so firmly adherent to one another that the membranes were torn in liberating the brain. Case of Head Injury with Religious Mania. H. SCHCJLE (" Sectionsergebnisse bei Geisteskranken," Leipsic, 1874) : A labourer, age forty-one, received some twenty years prior to admission an injury on the top of his head which never caused him any inconvenience, though there was a bony deficiency, the size of a florin, one-third of an inch behind the coronal suture in the middle line, where post mortem a piece of iron was found embedded, causing degeneration of the brain substance around. Patient was ad- mitted for mania. Fourteen days after his admission he began the solemn recitation of bibhcal sentences with increased excitement, so that he had to be isolated. He continued to preach fervently in his cell, and gave Bible quotations with a de- clamatory voice. His temperature rose. A cold bath reduced it again, and he then began the preaching anew, with a further rise of temperature and quickened pulse. He got generally exhausted by the morning. The fever and the maniacal excitement of a religious character always went together, and no treatment seemed to prove of avail. He died of pneumonia about three months after admission. Lesion of Upper Frontal Region followed by Religious Mania. A. P. MILLER ("Medical and Surgical Journal," vol. iv.) : A clergyman who had neglected his health had a sudden outbreak of insanity. He had called on a notorious drunkard to convert him to better ways, and was turned out of the house by him. This conduct had such an effect on his already excited feelings that he rushed into the pubhc square, holding the Bible in the air, and knelt down praying to God to subdue the obduracy of the sinner's heart, and rising up began most vociferously to exliort people to repentance, for sin had darkened the land, and the judgment of God was coming upon earth. After much dif&culty he was compelled to go home, where he ran up to his bedroom, stripping. INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 105 and washing himself by dashing basins of cold water over his body, and praying most earnestly "that the waters of life he was now washing in would cleanse his soul from all sin." This process he repeated thrice, and such was the intensity of his conviction respecting his own impurity that each time he determinedly refused to be dressed in the same clothes, because they were unclean. He died twelve days after the event. Post mortem was found haemorrhage limited to the upper end of the superior and middle frontal convolutions. Case of Brain Tumour with Religious Mania, JOHN B. CHAPIN ("American Journal of Insanity," 1862) : E., male, age twenty-three, single, farmer, no hereditary tendency to disease. Hitherto healthy and industrious. Came voluntarily to the asylum. Suffering from religious mania. Devoted to religious subjects and a religious life. Oc- casionally a reaction of profanity. Post mortem, a tubercular tumour was found, the size of a walnut, at the vertex of the brain. Case of Head Injury with Religious Delusions. E. BROWN (" Alienist and Neurologist," 1883) : J. K., age thirty-nine, was a quiet and orderly youth before the injury. He entered the army early in the American Civil War, and was struck on the head, where the wound left a cicatrix over the junction of the coronal and sagittal sutures. He remained unconscious for twenty-seven hours. On his return home he was found to have undergone a complete change of character. There was loss of control over his temper, together \vith religious delusions. Cases of Frontal Tumours with Religious Mania. VOGELIN, " AUg. Zeitschrift f. Psychiatrie " 1898. GIANELLI, " Policlinico, " 1897; two cases of loss of moral and religious sentiments. THE CENTRES OF APPERCEPTION The frontal lobes contain the centres necessary for the various elementary apper- ceptions. As has been explained in Chapter XXVH., we must distinguish in the act of vision between the mere perception of an object and an intelligent know- ledge thereof as to its nature and qualities. We must distinguish between acts of pure sensation and the mental acts of symbolic representation. Perception is a complex process, and consists not only of the visual impression, but the impression of solidity.form, size and position, which vision alone would never give without the aid of the other senses. Our various representations, the different impressions made by the senses, would not exist for us without an element which gives them unity and makes them an object of understanding. Perception is, then, sensation plus intellection. The sensory ideas, whether visual, auditory, tactile, or other, on entering the domain of consciousness, are studied in all their relations to self and the external world. The visual centre may see an object, but the perceptive centre looks at an object and ascertains its significance and attributes — their form, size, weight, colour, order, number, etc. It is not enough, therefore, to ascertain that a patient after injury to his brain can see an object ; we must also ascertain whether he can see all its attributes. The part of the brain that sees the object is a difierent part from the one that recognises it. The centre of sensation is not the centre of perception. In cortical bUndness, NOTHNAGEL (1841-1905), as long ago as 1882, observed that the power of calling up visual images remained unafiected. Sense-deceptions, according to this theory, may be regarded as a disruption in the connecting link between the actual sensory and the co-ordinating centres. The powers of perception give retentiveness as well, and thus supply the raw material for our practical knowledge. io6 THE MENTAL FUNCTIONS OF THE BRAIN To understand how important a factor memory is in mental operations, we have only to conceive what the mind would be ^vithout it. Without memory there would be no past, only a perpetual present, therefore no possibility of comparing past states with present ones. The mind would be the subject of a series of sensations and of nothing more. But with memory, perception is possible ; we recognise the relations between one sensation and another ; we can form ideas ; we can think and feel. Memory is a necessary condition of personal identity ; it is, in fact, as HUME puts it, only another name for consciousness. It is usual to employ the word " memory " in a general sense to express the property, common to all thinking beings, of preserving and reproducing the im- pressions they have received ; but psychological analysis and a large number of facts in mental pathology have demonstrated that memory should not be regarded as a single faculty, having a distinct seat. Every ceil of the brain and of the body has its own memory. If memory were a distinctive power, it would be alike strong for all subjects. But as this is not consistent with fact, we are forced to the con- clusion that there is no general faculty called memory, but that each faculty has its own power of recalling its impressions. One individual remembers existences, another events, a third recalls with ease a train of reasoning, another musical airs, another the faces he has seen or the scenes he has surveyed ; each perhaps weakly remembering something else of the matters now enumerated. Each of these memories may become lost in injury or disease of the frontal lobes, while the others remain intact and unaffected in the slightest degree. From this we are led to infer that they must possess anatomical independence. BIANCHI, of Naples, found that after destruction of the cortex of the pre-frontal lobes in dogs and monkeys not only were memory, attention, and the judgment impaired, but the animals did not recognise either the places or persons with whom they had been previously familiar. GOLTZ found that dogs in whom he had removed the pre-frontal region of the brain acted differently from normal animals. Very remarkable is the following experiment which he made. " If a bone is thrown to the animal at some distance it runs to it with great alacrity, but does not have the sense to stop at the right moment and sink its head, so that it runs beyond the mark, as if it had lost the sense of distance. Instead, however, of turning round and looking for the bone in a methodical way, the animal appears to forget what it was after, and runs on regard- lessly until the bone is lifted and the animal's attention again attracted to it." WUNDT, admittedly an authority on physiological and experimental psychology, held that perception must take place in a higher centre where all the sensory impressions are co-ordinated — that is, in a perceptive centre, which he locates in the frontal lobes. There exist partial, special, or local memories, each of which has its special domain, and which are so independent that one of them may get enfeebled or disappear, or may develop to excess without the others necessarily presenting any corresponding change. We have already dealt with the speech centre. Here we need refer only to the fact that the memory for words may be lost and the memory for tones, number, etc. — and their expression — may be preserved intact. The ability to recognise the form of an object, as well as its nature — the stereog- nostic sense — may be lost independently. This is recognised by MILLS, HOPPE, and WEISENBURG, but they locate it in the superior part of the parietal lobe ; whereas the cases quoted in the succeeding pages show it to be in the orbital con- volutions. The independence of the stereognostic sense — without giving any locahty— is also recognised by ROBERT SOMMER (" Zeitschrift f. Physiologic der Sinnesorgane," vol. ii.), BERGMANN (" Allg. Zeitschrift f. Psychiatrie, " vol. vi.), and HEBOLD (" Archiv f. Psychiatrie," 1885) on the basis of definite cases. INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 107 WILLBRAND observed the loss of appreciation of time. FORSTER (" Archiv f. Ophthalmologic, " vol. xxvi.) observed the loss of the memory for places. GROEUNOW ("Archiv f. Psychiatrie," vol. xxiii.) did the same. Similar observations by Bjernum, Brill, Cohen, Schnelle, etc. SAMUELSOHN had a case under his charge where, after an apoplectic seizure, the sense of space and light was intact, but the colour sense was utterly extinguished (" Centralblatt f. die mediz. Wissenschaften," 1882). STEFFEN (" Graefe's Archiv," vol. xxvii.) had a similar case, and concluded from it " that in the main central organ, the brain, the centre for the sense of ' space ' and for the sense of ' colour ' are divided, no matter how near to each other they may be estimated, but there is a special centre for each of these senses." The well-known effects of intoxication by hashish also point to the existence of special centres for the appreciation of time and space. The notion of time is com- pletely overthrown, the moments are years, and the minutes centuries. Short distances seem immense. In this illusion a bridge or an avenue appears to have no end, and to be prolonged to unheard-of and impossible distances. In ascending a staircase the steps seem to rise to heaven ; a river, whose opposite bank can be seen, appears as large as an arm of the sea. These two delusions last more than twenty- four hours after the injection of the poison. Idiot children have sometimes talents in special directions, which are all the more remarkable because of their lack of sense in every other direction. We can only explain such natural gifts by assuming that they are dependent on special centres in the brain, which are rich in neurones as compared with the remainder of the cortex. It is not uncommon to find in idiot institutions children with an extraordmary talent for remembering dates and past events. Several children under Dr. LANGDON DOWN'S care have possessed this faculty to an exceptional degree. One idiot boy never failed to be able to tell the name and address of every con- fectioner's shop that he had visited in London — and they had been numerous — and could as readily tell the date of each visit. Another could tell the time of arrival of all the children at the institution, and could supply accurate records in relation to it when needed. One boy under Dr. Down's care had a very unusual faculty, namely, the perfect appreciation of past or passing time. He was seventeen years of age, and although not understanding, so far as he could gather, the use of a clock- face, could tell the time to a minute at any part of the day, and under any circum- stances. Dr. Down tried him on numberless occasions, and he always answered with an amount of precision truly remarkable. Dr. E. T. BOLAND brought before the New England Psychological Society, October nth, 1887, an idiot-savant, a boy named George, sixteen years old, whose strong point was that he could answer questions as to calendar dates in his past life and for a year or two in the future. He had never learned to read, sight being too defective even had his capacity permitted. He was an imbecile in every respect. Dr. SHUTTLEWORTH had in his institution a remarkable case of a young man with a history of congenital imbecility who was able, without much mental effort, to give the day of the week corresponding to the day of the month for several years past and for several years to come. His ready answers were very surprising to strangers. EXAMPLES OF LOSS OF SPECIAL PERCEPTIONS AND MEMORIES The author's observation of a case of Loss of Form, Size and Weight, and Memory of Dates and Names. E. M. J., a farmer, age sixty, received a kick from a horse on his forehead, crushing in the skull at the root of the nose along the level of the eyebrows, the fracture extending upwards to the middle of the forehead, showing afterwards an io8 THE MENTAL FUNCTIONS OF THE BRAIN unsightly depression at the seat of injury. The patient, who remained in a semi- conscious condition for several weeks after the occurrence, made a gradual recovery, but the following symptoms remained. He was able to walk about and look after his farm affairs, but he found that he had lost interest. It was noticed that he could not learn and observe things as before ; that he could not remember dates, names, or even recognise faces and forms as readily as before. He who could formerly guess at distances correctly could no longer measure them with the eye. Form, size, width, and height seemed changed to him. Formerly a good shot, he could not aim at any object now, a bird in the air appearing a long way off, when in fact it would be near or almost directly over him. Nor could he estimate the weight of cattle, dogs, and horses, at which he was naturally clever before the accident. He spoke rationally and was perfectly normal in every other capacity and disposition, except that he had an inclination to frequent anger without apparent cause. This was the only loss of control that could be ascertained. Another case of my own observation of Loss of Sense of Size and Weight. H. B., age fifty-five, a tailor, was hit in a quarrel by a billiard ball over the left eye, fracturing the skull over the supra-orbital foramen. After recovering conscious- ness, he suffered from agonising attacks of supra-orbital neuralgia, for which he was treated. As regards the mental condition, it has to be noted that the patient lost control over his feelings, and for a time was considered insane. He recovered, how- ever, completely and became a normal man but for the loss of appreciation of size and weight, so that he could no longer cut clothes or fit coats. Case of Frontal Injury with Loss of Memory of Previous Events, of Forms, Objects, and Places. H. M. ABEL and VV. S. COLMAN (" British Medical Journal," 1895) : G. T., a sober, well-conducted railway fireman, age thirty-six, was brought to the Peterborough Infirmary with the broken ends of an oil-feeder protruding from his right cheek, a little behind the angle of the mouth. It was stated that in stepping from the tender on to the footplate of his engine, with the oil-feeder in his hand, he slipped and fell forwards, the spout of the oil-can being driven forcibly into his face. He was then quite senseless, but partially recovered consciousness in a few minutes. When he was being placed on the stretcher, someone suggested a coat for his head, and he was sensible enough at that time to say that his own coat was on the engine ; so that the loss of memory, afterwards so conspicuous, was not then present. He reached the hospital quite conscious. The metal spout of the oil-can was firmly fixed in the base of his skull, and required firm traction with forceps to relieve it from the grasp of the bone. It passed upwards and towards the middle line, and the concavity of the spout was directed from the middle line, the end of the oil-can entering the skull at the inner corner of the right eye, reaching up to the middle of the forehead. There was now paralysis of the left side of the face and left arm, while the left leg was little affected. Mental condition : He couid not recognise his wife or his old comrades, and he had also difficulty in recognising common objects and their uses. He did not recognise a fellow-workman who met with an accident and was in a bed next to him for weeks. But what was most remarkable was that the whole of his life for twenty years before the accident was wiped out from his memory. He asserted he was a farm labourer, which he was before he worked on the railway. All the memory of the accident was gone, and has never returned. After he left the hospital some previous events did return, but after the lapse of a year there were still five years of which he could not remember anything. The paralysis had nearly disappeared, only the arm was left weak. There was very little control over his emotions. He laughed or cried at the slightest provocation. His irritabihty of temper was said to have increased, and he was often hasty in his language, although not violent. The partial return of his memory seems to have been in part due to the habit of his " mates " coming in and talking to him of the past, and continually reminding him of occurrences which were likely to have made an impression on him. There was still extreme difficulty in retaining in his memory any passing events. If he went out for a walk by himself he was unable to find his INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 109 way back, and often failed to recognise his own hoase when he was outside ; and there was also frequent failure to recognise common objects and their uses. There was present therefore a condition of imperception. There was no aphasia at any time, and no difi&culty in expressing himself. His reasoning processes were fairly orderly, but as, owing to the blanks in his memory, he often argued from false premises, he arrived at ludicrously incorrect conclusions. For example, he occupied one of the houses built by the railway company for their servants, and as he had no recollection of having worked for them for five or six years, he argued that he had no right to be there, and insisted with unnecessary warmth that his wife should pack up and leave the house before they got into trouble for being there. Case of Frontal Tumour with Disorientation and Loss of Memory and Sense of Time. F. X. DERCUM ("Journal of Nervous and Mental Disease," 1910) : I. G. C. L., age fifty-nine, book-keeper. " His wife reported that he had been in a ' dreamy ' state of mind for some time and that he seemed to have no idea of time. He often forgets what he is doing. At times he does not seem to know just where he is ; sometimes loses himself in his own house. His wife states further that he does not seem to notice the change in his condition ; that he does not manifest any anxiety about himself. He does not worry and assumes no responsibility re- garding his affairs." Post mortem, a sarcomatous tumour was found in the right frontal lobe. Case of Frontal Tumour with Loss of Memory for Facts and Events. LEONIDA CANALI (" Rivista Sperimentali de Froniatria," i88i) : Antoine Ruggeri, age forty-four, a priest, struck his forehead against a wooden post in his house. Remained unconscious for about an hour. The injury and subsequent headache was in the region of the right frontal eminence. A year later mental changes followed. He became loquacious, his memory for facts and events got markedly enfeebled, and his ideas disordered. Gradually he also lost control over his character tendencies, became haughty, irascible, and intolerant. Eighteen months later died in a fit. The autopsy revealed a glio-sarcoma involving the middle of the first and second frontal convolutions on each side. Case of Frontal Tumour — Euphoria, Loss of Sense of Time, Place and Number. GABRIEL GHEZE (" fecho Medical du Nord," 1910) : Marie V., age forty-two, found wandering in a state of nudity, smiled happily, had optimistic notions, no knowledge of time and place, no idea of simple calculation. Died five days later. A large sarcomatous tumour was lying across the orbital plates of the frontal bone, compressing the orbital convolutions, which were partially destroyed. Case of Frontal Injury — Loss of Sense of Weight and Sense of Resistance. THOS. LAYCOCK ("Australian Medical Journal," 1893) : A case of fracture of the base of the skull just behind the orbits, there being a fissure about a quarter of an inch in width. The patient, a man, age tw^enty-nine, was treated surgically. Much lacerated and contused brain substance was removed. On recovery, patient had lost the conception of the quahty and position of foreign bodies, their weight and resistance, through the sense of touch. Case of Frontal Injury — Loss of Sense of Time, of Locality, and of Objects. J. WENDE (" Allg. Zeitschrift f. Psychiatrie," 1905) : Patient, age thirty-three, fell off a scaffolding seven feet high, when the right side of his forehead struck an iron screw and he sustained a wound about four centimetres in length. He was rendered senseless, but soon recovered conscious- ness. Subsequently he frequently lost control over his temper, and there was absolute loss of the sense of time, complete failure of self-orientation, and inability to notice things. no THE MENTAL FUNCTIONS OF THE BRAIN Case of Frontal Lesion — Loss of Sense of Time, Memory of Places and of Objects. M. JASTROWITZ (" Deutsche Medizinische Wochenschrift," 1887) : Patient, wife of a major in the army, age forty-two, had a syphiUtic scar of three centimetres in length over the glabella above the root of the nose. Though in- tellectually quite normal, she could not distinguish either time or locality, and mistook objects. The post-mortem examination revealed intermeningeal haemor- rhage at the anterior root of the superior and middle frontal convolutions. EXAMPLES OF RECOVERY OF MEMORY AFTER SURGICAL OPERATION Case of Frontal Tumour with Enfeeblement of Perception and Memory — Surgical Operation — Recovery. GIANELLI (" Policlinico," 1897) : Patient manifested slowness of perception and confusion of memory. On removal of the tumour complete recovery. Case of Frontal Tumour with Loss of Memory — Operation — Recovery. SEYDEL (" Neurologisches Centralblatt," 1896) : Case of loss of memory, loss of all interest, apathy. Removal of tumour led to complete recovery. Case of Frontal Tumour with Lossof Memory for Facts and Events — Surgical Operation — Recovery. FRANCESCO DURANTE, Rome ("British Medical Journal," 1902) : S. D., age thirty-nine, suffered from " slow perception, mnemonic confusion for remote facts, and abolition of memory for recent facts." On operation, large subcortical gumma involving nearly the whole of the left frontal lobe was removed. Result : " Complete cure of all the sj'-mptoms." ARITHMETICAL ABILITY There are two things necessary for an ability to reckon rapidly : a powerful memory for figures and a real ability for calculating. The carrying out of long calculations in the mind depends, above all, on the accuracy of the memory for a sufficient length of time. The power to commit a group of objects or a line of a dozen figures rapidly to memory and to call it up again instantly depends on the ease and rapidity with which one can impress it on the mind, on the accuracy with which it is reckoned, and the ease and rapidity with which it can be reproduced. The ease and rapidity with which a number of objects can be impressed on the memory seem limited in ordinary persons to about five at a glance. In regard to a special inclination for mathematics and its relation to ability for calculation, and to other abilities likewise, great diversity is exhibited. There are those having pronounced arithmetical bent combined with great powers of mental calculation, though not necessarily rapid. Mathematicians are not necessarily distinguished rapid arithmeticians. In fact, they rarely have a hking for mere reckoning. There are those with inclination and ability for mathematics, including arithmetic. Those with special inchnation and arithmetic solely : [a) such as have had no opportunities afforded for cultivating other branches of mathematics ; (&) in spite of opportunities afiorded ; (c) where the talent disappears ere an opportunity for development is rendered possible. There are children whose apathy nothing would seem capable of arousing, and others, again, who take keen interest in everything, and amuse themselves with even mathematical calculations without any end in view. Still others there are more INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN iii rarely than either of the aforesaid groups, who limit their interest to mathematical calculations merely. Strange as the fascination for arithmetic seems, it becomes still more so when it is manifested at an age at which it is normally absent ; strangest of all is the union of ability with the inclination. The great calculators showed precocity for figures at three years of age, some at six, and most of them before ten years of age. One peculiarity in the imaginative powers of arithmetical prodigies is worthy of notice, namely their visual imagery, their capacity of carrying a vivid mental picture — a photograph — of the numbers, with which they are at the time occupied ; and this without a corresponding visual memory for words. Among the great arithmetical prodigies are : NICKOMACHOS, of Gerasa {ca. 30 a.d.), mentioned by Lucianus. THOMAS FULLER (1710-1790), the Virginian calculator. JEDEDIAH BUXTON (1707-1772), of Derbyshire, England. ANDR£ marie ampere (1775-1836), of Marseilles. CARL FRIEDRICH GAUSS (1777-1855), of Brunswick. RICHARD WHATELY (1787-1863), Archbishop of Dublin. ZERAH COLBURN (1804-1S40). VITO MANGIAMELE {ca. 1837), of Sicily. ZACHARIAS DAHSE (1824-1861), of Hamburg. C. GRANDMANGE {ca. 1852), of Paris, bom without legs or arms. HENRI MONDEAUX (1826-1862). GEORGE BIDDER (1806-1876), engineer. TRUMAN HENRY SAFFORD (1836-), of the United States. JACQUES INAUDI (1867-). GaU observed several calculating boys of his time and located the centre of the sense of "number " (Zahlensinn) at the inferior and external root of the frontal convolutions, a point which from his brain plates I make out to be the supra-orbital end of the third frontal convolution, corresponding to the external angle of the eye. He exhibited a boy from St. Poelten, near Vienna, son of a blacksmith, who had received no teaching, but was quicker in calculating rows of figures by head than others were on paper. A barrister consulted Gall about his son, age five, who busied himself extensively with numbers and calculations, so that it was impossible to fix his attention on anything else. Gall knew also a boy, age seven, named Devaux, whose greatest pleasure it was to go to all the fairs and check oflE the traders' calculations when they were making up their accounts. His works contain numerous other examples, including cases of calculating idiots. The appreciation of number is a primitive sense, but not the capacity for mathe- matics, which is a complex ability. Yet P. J. MOBIUS (1853-1907), who attempted to revive Gall's doctrines in Germany (see Chapter XVI.), fell into this error. In a lecture delivered at the fifth meeting of Alienists and Neurologists of Central Germany at Leipsic, 1899, he declared : "I have not closed the investigation as yet, but I have got far enough to enable me to say with full conviction, in this localisation Gall was completely right. I have found all his statements correct, and only one thing Gall left unmentioned, that th^ development of the mathematical organ is more often to be observed on the left side." Mobius, in his work, " Uber die Anlage zur Mathematik," Leipsic (1900), gave a collection of mathematicians (male and female) from ancient to recent times, with their biographies, psycho- logical analyses, and cranial formations. PAUL FLECHSIG (1847-1904), at the meeting just mentioned, declared that 112 THE MENTAL FUNCTIONS OF THE BRAIN probably the faculty of "number " was located in the lowest part of the third frontal convolution ; exactly where Gall believed it to be. A. BINET (1857- 1 911) had studied Inaudi and Diamandi, who were examined by the Academy of Sciences in Paris. I saw Inaudi in London. A line of figures, casually suggested by members of the audience, was multiplied by another line, and the product given with astonishing rapidity. The cyphers were written on a black- board behind the performer, so that they could be read by the spectators, but not by Inaudi. Nevertheless he was able to hold in his memory and repeat all the figures. In adding he used to begin at the left side with the higher numbers. He dealt with the numbers as sounds — that is, they had to be repeated to him orally — whereas Diamandi regarded them as seen figures. Binet observed that, besides the capacity of keeping the figures in memory and rapidly calculating, it is of importance that the reckoners should keep up the use of their talent ; for without practice they seem to lose much of their facility. The pos- sessors of this wonderful faculty generally come of obscure famihes who never showed particular skill in arithmetic. Arithmetical ability is not confined to Europeans. In the Korea Magazine, May, 191 7, is an account by W. CARL RUFUS, Ph.D., of An Myeng^vhan, a Korean lad, sixteen years of age, in the employ of the Land Investigation Bureau. He is described as a perfect human adding machine. He can add up twenty-five items of four figures each in seven seconds by mental calculation, and when using an abacus the time required by him in making the same addition is eight seconds. Frequently at night he sees columns of figures before his closed eyes. On the other hand, there are men with a congenital deficiency in tlie faculty of number, for example, George Combe. He said : " Arithmetic has always been a profound mystery to me, and to master the multiphcation table an insurmountable task. I could not tell how much eight times nine are without going to work circuitously and reaching it by means of the tens, yet for seven years I studied arithmetic. The faculty in me is, in fact, idiotic. Were any other powers in hke condition, I should be totally unfit for the ordinary business of life." Arithmetical ability is one of the capacities that cannot be explained by any process of development through the struggle for existence or sexual selection. Yet the arithmetical talent seems to be a special faculty of the human mind. Though all normal children can be taught to count, some learn quickly, others slowly. Some men take a deUght in working at arithmetical problems, others have a dis- taste for them. It often happens that those who are very skilful in solving arith- metical problems have no unusual abihty for anjrthing else. It is curious that in the mental manifestations in idiocy and imbecility we find that of all human faculties that of music is the best preserved, whereas that of number is tile most deficient, yet music seems to have a certain connection with number. A tune depends upon the numerical relation of certain notes to one another, and upon their succession in time. Even idiots who cannot speak catch up tunes and hum or grunt them. To be able to learn to speak is a measure in the capacity of imbeciles, but speech may be freely exercised without there being ability to count. This deficiency is universal, comprising all classes of imbeciles. The old legal definition of an idiot is " one who cannot count twenty pence." The greater number of idiots cannot count three, but among imbeciles are sometimes found children wonderfully skilled in calculations of various sorts, though with no other ability. Dr. DESRUELLES, of the Asylum of Armentieres, published in " L'Encephale," 1 91 2, a very interesting and valuable description of a new case where phenomenal ability in arithmetical calculation is associated \vith general mental inferiority, if INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 113 not actual insanity, and whete, further, there is a curious complication in the fact that the patient has been blind from birth, and therefore can have no visual memory. Fleury is a young man of eighteen, who suffered from ophthalmia neonatorum and is completely blind. He has never been teachable in any way, has always proved refractory and difficult to manage, and has passed from an institution for the blind to an asylum. The only thing successfully taught him has been the Braille system, but his capacity for reading thereby is by no means well developed. On the other hand, he has from an early age shown himself exceedingly apt in figures, and partly by persevering with the Braille method, partly by devising certain mental methods for himself, he has reached a stage of extraordinary facility in performing elaborate calculations, the extent of which is limited only by his difficulty in remembering any set of figures beyond six. Psychologically the case is of great value, for it must be remembered that Fleury has no visual memories at all, and on questioning him he denies that he uses his auditory niemory to any extent. It is clear that his tactile memories are so remarkably developed that by them alone, coupled with certain other processes, he is able to perform mental feats of an astonishing kind. When he calculates he uses his fingers constantly, as though he were feeling the familiar raised Braille figures with them, and while he mutters to himself as he does this, it is not figures that he is repeating, but such fragments as " that makes . . ." " then . . .", " added to . . .", etc. All of Fleury's calculations are mental ; he does not repeat figures with his lips. Here are some examples : He multiplied 825 by 825 in four seconds ; given a day of the week in 191 2, he calculated May 22nd, 1908, as a Friday, in five seconds ; asked how many seconds in 39 years, 3 months, and 12 hours, he gave the correct answer, 1,238,587,200, in i minute 15 seconds. A. WIZEL ("Archiv f. Psychiatric," 1904) described a phenomenal talent of counting in an imbecile : Sabina W., age twenty-two, inmate of a hospital at Warsaw. The family had a special gift for music, but none for arithmetic. Patient normal till seven, when she had severe epileptic fits, followed by unconsciousness lasting for several days, leaving her an absolute imbecile. When she was eleven she was mentally the equal of a child of three. The epileptic seizures continued, though in a milder form, but they were followed by fits of violence. At the age of twenty-two she was still weak-minded. She could not tell how old she was, or how many brothers and sisters she had ; she could not read or write, could not read figures, and could only talk on childish subjects. She had no affection for anybody and could not keep herself clean. But she had remarkable faculty for arithmetic, being especially good at multiplication and division. She divided 576, 560, and 336 by 16, and 225 and 270 by 15, with astonishing quickness ; yet she failed in simple addition and subtraction, giving often the right answers, but much more slowly. Sabina possessed another power which is rarely met with in ordinary people. Once Dr. Wizel asked her : " What is the product of 23 x 23 ? " She quicldy gave 529, and added, " That comes to as much as 33 x 16 and i." Dr. Wizel gives numerous other examples. It was difficult to get Sabina to explain by what processes she so rapidly got her answers ; but one example may explain. Asked 45 x 18, she answered 810 ; Dr. Wizel thinks she multiplied 90 by 9. Case of Head Injury with Loss of the Faculty of Number. K. RIEGER (" Central blatt f. Nervenheilkunde, " 1887) showed at a meeting of the Medical Association at Wurzburg a patient, Mr. Seybold, a sculptor of Carlstadt, who received a fracture of the base of the skull in a railway accident. Patient spoke a bit slowly, and was weaker in his memory than before the accident, but the chief symptom was, that he had forgotten all ideas of figures beyond i, 2, and 3. Case of Aphasia with Retention of Expression of Figures. VOLLAND (" Miinchener Medizinische Wochenschrift," 1886) : A farmer's son, age fifteen, had a fall which injured the scalp but not the bone. When he recovered consciousness, after several days, he understood everything that was said to him, but could only reply one word, " Anna," by speech or in writing. Vol. ii.] I 114 THE MENTAL FUNCTION^ OF THE BRAIN Yet he was able to count up to loo, to recite the multipUcation table, and to add or subtract figures. He could write all figures and calculate correctly on paper. Gradually he acquired the power to speak whole sentences, but did not get on well at school, except in arithmetic, in which he was equal to the best. Six years after the accident he was still somewhat aphasic, had attacks of giddiness and sUght ptosis. This case shows that the formation and expression of words must be anatomi- cally separate from the formation and expression of figures. Another Case of Aphasia with Retention of Expression of Figures. SCHRODER VAN DER KOLK ("Pathology and Therapeutics of Mental Disease," p. 14) : A tradesman came, conducted by his son, to obtain the doctor's advice. About half a year back the father had an apoplectic attack of only short duration and which left no paralysis ; yet the memory for names or words had in a great measure vanished, so that he called objects by wrong names, and, for example, used the word " chair " when he meant a table. Yet he well knew the word " chair " was not the usual one, and he brought forward other words until at last he came to " table," which word he then pronounced with great satisfaction. But there was yet another remarkable suppression, such as the doctor had not before observed. The patient was no longer able to read, although the sight was not impaired. On a large printed book being placed before the man, he distinguished the letters in it quite well, and spelt, for example, the word " towards," but he was not able to combine these letters into a word. The man had also lost the capacity of writing, so that he could no longer sign his name. But the most remarkable circumstance with this patient was, that he could still, according to the assurance of his son, keep his ledger and reckon now as ever before. Other Cases of Aphasia with Retention of Expression of Figures. MARCE (" Gazette Medicale de Paris," 1856) : Case II. Patient distinguished single letters' quite well, but was no longer able to combine tliem into a word. He transcribed a word quite correctly, but could not write it when it was dictated to him. Yet he could write figures very well. Case 7. The patient could not write his name from memory, but wrote figures and solved complicated arithmetical exercises, always setting the figures in their proper places. OTTO HEBOLD (" Allg. Zeitschrift f. Psychiatrie," 1894) : H. G., had loss of speech but could calculate correctly. PRINGLE MORGAN ("British Medical Journal," 1896) : Recorded a case in which the memory for words and letters was lost, but not that for figures ; from which he infers that there is not only a complete functional independence of these two faculties, but also an anatomical independence. HEILLY and CHANTEMESSE (" Progr^s Medical," vol. xi.) : A case of sensory aphasia with the power of calculation preserved. Authors mention that patient could play 6carte correctly. A. CHAUFFARD (" Revue de Medecine," 1881) : Case of sensory aphasia. Had a tendency to substitute numerals for words. His appreciation for music was well preserved, though he complained that he could not hear words. DfejERINE (" Comptes rendus des seances de la Societe de Biologic," 1892) : Patient, although word-bUnd, could write as fluently as ever. He could copy correctly pages of manuscript, although he could not read a word he had written. He had also lost the power of reading musical notes, but he could still sing well. He could read figures and do mental calculations just as well as ever. BRANDENBURG (Graefe's " Archiv f. Ophthalmologic," 1888) : A hitherto healthy man had an apopleptic stroke, which made him temporarily aphasic. There was alexia but no agraphia. The patient could write anything but could not read, with the exception of figures, so that the reading of numbers was preserved . M. LANNOIS (" Lyon Medical." il INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 115 Patient, age thirty-two, had been for three years in a condition of complete amnesia, with the exception of the memory for figures. He could not write spon- taneously anything except figures, and calculating remained his only occupation. JAMES HINSHELWOOD ("Lancet," 1895) : A teacher of languages, age fifty-eight, who had of recent years a large amount of mental work and, before his present visual difficulties appeared, considerable mental worry and anxiety, found suddenly one morning that he could not read the exercises as usual. Greatly puzzled, he took up a printed book, and found that he could not read a single word. On examining his visual acuity. Dr. Hinshelwood found that he was unable to read even the largest letters of the test types. Patient informed him that he could see all the letters plainly and distinctly, but could not say what they were. Wliat attracted special attention was the fact that the patient read at once the number standing at the top of each paragraph of the test types. On examining him further, it was found that he did not experience the slightest diffi- culty in reading any number of figures quite fluently and without making any mistakes whatever. He could read figures printed on the same scale as Jaeger No. I, the smallest of the test types, and from other tests it was evident that there was no lowering of his visual acuity. The inability to read was thus manifestly not due to any failure of visual power, but to a loss of the \dsual memory for letters. The page of a printed book appeared to him exactly as it appears to a person who has never learned to read. He saw each individual character distinctly enough, but the character was no longer a visual symbol, as he no longer remembered the special significance attached to it. His difficulty with written characters was equally well marked. He could write with perfect fluency and ease to dictation, although afterwards he could not read what he himself had written. He spoke as fluently as ever. Patient was tested further with large combinations of figures, and all these were read with the greatest fluency, and without any hesitation whatever. Cases of arithmomaniacs — patients dominated by an irresistible impulse to count everything and to make useless calculations — while otherwise of normal intellect and conduct, have been reported by TRELAT (" La FoUe Lucide "), A. CULL£;RE (" Annales Medico-Psychologiques," 1890), and LUDWIG BRUNS (" Neurologisches Centralblatt, " 1891). MUSICAL ABILITY It would be difficult to settle what are distinct talents or innate gifts, but it will scarcely be denied that the musical talent is one of them. Nevertheless, it is made up of a number of elements, of which the principal one is the sense of appreciation of tones. The appreciation of sounds alone is not music. Music is a harmonious arrangement of sounds. The " time " sense among other factors is required to appreciate it. The lowest species of musical gift is the simple pleasure derived from hearing music, then that of remembering tunes, and of singing and performing. The title of musical genius is often reserved for great composers, but many great per- formers who cannot compose are spoken of as possessing musical genius. Between the highest and the lowest it is but a question of degree. In persons who, in common language, have no ear for music, there is not deafness properly so-called, but an inabihty of the nervous structure to appreciate the minute vibrations which are caused by the more subtle differences in or among musical sounds. Sir ASTLEY COOPER mentioned the case of a man who was very deaf from childhood, and who, notwithstanding, appreciated harmony ; this person played well on the flute, and performed with great success in concerts. DARWIN knew a child who loved music extremely, who easily retained an air after hearing it sung distinctly, and whose organ of hearing was yet so imperfect that it was necessary to speak very loudly in addressing him. ii6 THE MENTAL FUNCTIONS OF THE BRAIN Memory of tune is a very common faculty among the feeble-minded. They readily acquire simple airs and rarely forget them. The turn for music is quite disproportionate to their other mental faculties, and not unfrequently those who cannot speak at all can hum tunes correctly. This remarkable relative develop- ment of the musical sense in the feeble-minded is the more striking on account of the utter absence of any other evidence of artistic taste. A beautiful landscape or a lovely picture is powerless to move them. The following casts, taken from living heads — all contemporaries — were in Gail's collection : Beethoven, Mozart, Haydn, Gliick, Liszt, Kreibig (the accompanist of Emperor Joseph II.), Marchesi, Catalani, Rossini, and numerous others whose names would not be known at the present day except by persons intimately acquainted with the history of music. In his " Atlas of Brain Plates " he places the centre for the appreciation of the relation of tones over the fissure of Sylvius, in the upper and lateral part of the brain, corresponding in the skull to the temporal region bordering on the supra-orbital ridge, which part, when prominent, as in musicians, appears broader than the inferior part of the forehead between the external angles of the eyes. Gall analysed the history of Handel, Mozart, and other musical prodigies ; described the musical disposition as it exists sometimes in idiots and the insane, and examined the differences in brain structure of singing and ordinary birds. How correct Gall was in recognising singing-birds by the shape of the head is related by PRINCE METTERNICH (1773-1859), the famous Chancellor and life- long patron of Gall, who used to accompany him to the Central Market in Vienna for the selection of singing-birds. To illustrate Gall's capacity we might mention also a mask in his Paris collection, labelled " Liszt : A mask taken from the hving head. A young Hungarian, who very early displayed a great talent for music, and cultivated it with enthusiasm. The formation of the tone-centre is very striking in the mask." Gall's successor, FOSSATI, who had also examined Liszt's head, reported ("Lancet," 1834) "although the shape of theforehead of Liszt has some analogy with that of Weber, yet he feared this young artist, with all his talent, was not capable of producing anything to be compared with works of a higher worth." Those who have known Liszt in his later days can certify that this prognosis, founded entirely on the shape of the head when Liszt was still a youth, was quite correct. Liszt remained one of the best performers, but his compositions were of minor value. BLIND TOM, as Thomas Wiggins was known throughout two continents for his wonderful musical genius, was little more than a child of feeble mind in all relations of hfe except that of music. He reproduced with an exactness Uttle short of the marvellous what he heard immediately before the reproduction. But the wonder was that, once having reproduced the execution of a musical composition, he never afterwards lost memory of it. He also composed some pieces of his own. He never, outside of music, rose above the intelligence of a child of six. His passion for music began when two years old, and he never lost it until a few days before he died, when he was stricken with apoplexy. In his retirement he spent eight hours of each day at the piano. The rest of his life was a blank. He made fortunes for his owners and guardians. He died in 1908, in his sixtieth year. He was of the pure negro race, bom in Georgia, a slave. His mother was bought by Col. James N. Bethune in 1850. She carried in her arms at the time a babe blind and so feeble that, in the sale, the babe was thrown in with the mother. He was the wonder of America and Europe, and although he was almost an imbecile in everything but music, in this he showed extraordinary talent. Dr. LANGDON DOWN had an idiot boy under his care who could tell the time, besides the words and number of nearly every hymn in Hymns Ancient and Modern. Another boy in his care, if he went to an opera, would carry away a recollection of all the airs, and would hum and sing them correctly. ESQUIROL (1772-1840) already had called attention to the fact that even idiots without the power of speech can sing. INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 117 WILDERMUTH (" Allg. Zeitschrift f. Psychiatrie," 1889) estimated that the musical capabihties are well developed in one-third of even badly speaking idiots, and though first-class musicians predominate amongst normal children, second, third, and fourth-class musical capacity existed more frequently amongst idiots. In insanity the musical faculty is often the last one to go. For example, Sir JOHN BATTY TUKE (1835-1913), " Journal of Mental Science " (1891), had two lady patients who, though quite incoherent in speech, played with great accuracy on the piano, the one by ear, the other by reading music, although the latter was quite unable to read a book, and had not dressed herself for twenty years. Music thus appears to be a rudimentary endowment which demands a much lower capacity than that of speech, and is less liable to be destroyed in mental decay. The appreciation of musical sounds appears much earlier in life than the ap- preciation of words. Children may sing, perceive and enjoy music before they speak. Dvorak's son manifested great delight at the sound of music when three months old, and retained the memory of melodies when one year old. That speech is unnecessary for the learning of melodies is also evidenced by birds — for instance, the bullfinches. Moreover, that the musical capacity is independent of the speech centre is shown by the loss of musical perception and of the ability to sing without the simultaneous loss of speech and the power of understanding spoken words. It is only within the last few decades that attention has been drawn to the fact that the musical capacity may be lost from various pathological causes, and, further, that musical aphasia may occur either in conjunction with ordinary aphasia or be independent of it. Cases are on record in which the patients, though " word-blind," still retained the power of reading musical notes. In other cases there is loss of the visual memory for musical notes, though they can read words. The patients can see the notes as usual, but they have no longer the faintest idea of their significance. They may be able to read the words of a song, but can no longer read the accompan>dng music. Similarly there may be deafness for spoken words without deafness for musical tones, or the reverse ; or there may be complete deafness for both. The notes are heard, but simply as sounds, without the patients being able to assign to them their position in the musical scale. H. OPPENHEIM (" Charite Annalen," 1888) found that many aphasics retain their musical faculty and are able to recognise and appreciate melodies and music when they have lost the power to understand language, and were able to sing sometimes even with words they could not speak ; others could read or write notes when they could not read or write words. He published clinical notes of seventeen cases of aphasia in which the musical faculty had been the subject of careful inquiry. The general result of these observations was that the musical faculty survived the loss of speech in aphasia, though in some patients the other mental powers were evidently injured. After the memory for melodies, the memory for numbers was found to be the best preserved. One patient, though he could not read ordinary letters, and could not write to dictation, nor copy writing properly, could quite well read and copy musical notes or write them to dictation. A. KNOBLAUCH (" Deutsches Archiv f . Klinische Medizin," 1888), who introduced the term " amusia " for the loss of the musical sense, cites the case of a little girl, Lizette S., age six, who had right hemiplegia with aphasia. The child could not speak at all at first. Later on she said " mampia," and apparently repeated a few words. She could sing the song " Weisst Dy wie viel Sternlein stehen," etc., but she could not recite the text of the song, or speak voluntarily single words of the same. Ii8 THE MENTAL FUNCTIONS OF THE BRAIN L. V. FRANK L-HOCHW ART (" Deutsche Zeitschrift f. Nervenheilkunde," 1891) studied the injury to the capacity for musical expression in five cases of aphasia. In all of these the musical power was less injured than that of speech. Some of them could sing words which they could not speak. Two could play from the music-book, one the violin, the other the piano, but they could not sing from it. J. B. BOUILLAUD (1796-1881), " Bulletins de I'Academie de Medecine," vol. xxx., almost a century ago, made the observation on a patient, age fifty, who had lost the memory for words almost entirely and could speak and write but little, that he could compose an original tune, watch carefully when it was played to him, and sing the words correctly to the accompaniment. J. P. FALRET (i 794-1 870), in 1867, called attention to the fact that many aphasics who are unable to speak are still able to sing ; some without words, but others with the words that they are unable to speak. E. C. LASEGUE (1816-1883) had an aphasic and agraphic patient who could write down a composition with ease after hearing it played to him. BALLET, in 1886, described musical aphasia, agraphia, and musical deafness. BRAZIER cites some cases in which there was no aphasia, but the patients could not distinguish musical airs with which they were usually familiar. ED6REN, of Stockholm, published in the "Deutsche Zeitschrift f. Nervenheilkunde," 1894, a collection of fifty-two cases of aphasia without amusia, and pure amusia without aphasia, showing the anatomical independence of the centres for speech and appreciation of tones. Other observers of the independence of the tone sense are Stumpf, Strieker, Wallaschek, Blocq, Brissaud, Donath, Wiirtzen, Marinesco, Lichtheim, Kahler, Pick, Wernicke, Anton, Larionow, Hughlings Jackson, Gowers, Grasset, and Hallopeau. Some observers assume that amusia may be situated in the anterior part of the first temporo-sphenoidal convolution, in front of Wernicke's area for word-deafness, but I am inclined from a study of the evidence to seek the centre for the appreciation of the relation of tones in the small anterior convolutions within the folds of the fissure of Sylvius that lie between the inferior frontal and superior temporal con- volutions. Its definite localisation, however, must be the subject of future in- vestigation. Here we must content ourselves in bringing the Uterature concerning this problem and records of cases together. PAUL FLECHSIG (1847-1904) discovered the end stations of the cochlea nerves in this region, and this localisation would also harmonise ^vith Ferrier's observations. PROBST (" Archiv f. Psychiatric," 1899) locates the tone-centre in the most anterior parts of the left temporal lobe. URQUHART (" Journal of Mental Science," 1904) found the lesion in a case of loss of musical capacity at the tip of the temporal lobe. BRONISLAWSKI ("Contribution a I'etude de I'amusie et de la localisation des centres musicaux. These de Bordeaux," 1900) locates the sensory centre for music in the anterior two-thirds of the first temporal convolution and the anterior half of the second ; and the motor centre for singing in the second left frontal convolution. He maps out several other centres for the different varieties of musical capacity, very much as others have located the various forms of aphasia all over the brain. He has even a special centre for wind instruments ! It is this sort of localisation that makes the whole problem appear ridiculous. MERCIER and NEWINGTON {" Journal of Mental Science," 1907) argued that the tone-sense cannot be localised. Case of Frontal Injury with Loss of Tone Sense. J. G. EDGREN (" Hygeia," 1894) : The patient, thirty-four years of age, on August 31st, 1890, knocked the side of his forehead against a lamp-post so that he fell to the ground. He complained of headache afterwards, of imperfect sight, of vomiting, of difficulty of speech, and INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 119 abnormality in the sense of taste. At first he could not eat at all. The next ievr days he took some water only, because he felt as if all food were remarkably hot ; even the water he drank appeared hot. After a week he began to eat, but he now complained that all the food was too much salted. On September 17th patient came home after a visit to several concert halls and declared he could not make out the music. He had tried several places intentionally, but though he could hear the music, it did not sound as usual, but more like an indefinite noise, so that he could not make out the melody. The reply his wife gave him he could not understand, and he himself spoke no more for two days. On September 20th he began to speak again, but in so confused and disconnected a manner that it was almost impossible to understand him. Admitted to hospital on September 23rd. He was word-deaf. He could hear when someone was speaking to him, but without understanding the words spoken. Written communications he apprehended immediately, and he could still calculate. He heard equally well on both sides ; he could hear the ticking of a watch at seven centimetres distance. His sense of smell was reduced ; he could not smell spirits or vinegar. On October 5th his sense of smell and taste were perfectly normal. His defects were therefore only temporary, with the exception of his tone-deafness. He left the hospital on November 3rd. Before the accident he had a good musical ear, which had now vanished, so that orchestral music was to him mere noise, and he could not distinguish a waltz from a polka or march. He used to sing to his children, but now when attempting to do so he failed, and lost the melody. On March 17th, 1893, he was readmitted for bronchitis and an eruption of purpura. Intellect quite normal ; no traces of aphasia, no word- deafness, only tone-deafness. The post-mortem examination revealed destruction of the anterior two-thirds of the first temporal convolution, and the anterior half of the second temporal convolution of the left hemisphere. Case of Frontal Injury with Loss of Musical Capacity. G. A. KCNIGSFELD, of Aix-la-Chapelle (" Zeitschrift f. Physiologie," Heidel- berg, 1843 : J. Trump, a singer, age eighteen, received a kick from a horse, resulting in a fissured fracture of the frontal bone, the fissure running from the outer corner of the left eyebrow upwards along the borderline of forehead and temple. The particles of bone were pressing on the brain, and the brain itself was contused. The wound suppurated, but got well after surgical treatment, a broad, deep scar being left. The patient had not suffered in intellect after his recovery, but had lost the memory of all the tunes he formerly knew. Case of Head Injury with Loss of Musical Capacity. A. KAST {" Deutsches Archiv f. Klinische Medizin," 1888) : A youth, age fifteen, fell from a cart and struck his head against the wheel. The accident was followed by loss of consciousness, which lasted several hours, and on restoration to consciousness it was found that the right side of the body was paralysed, and that, though he seemed to comprehend what was said to him, he could not utter a word. The paralysis slowly disappeared. At the end of two months the aphasia had altered its character. The boy was no longer unable to speak, but he had completely lost the artistic use of his vocal cords, though prior to his accident he was a distinguished member of a choral society. He sang dis- cordantly and quite out of tune, and could not correctly follow the lead of another singer. Case of Head Injury with Temporary Loss of Musical Capacity. THOMAS D. SAVILL (" Chnical Lectures on Neurasthenia," 1908) : Mrs. Z., age forty-one, a professional singer and pianist, was struck severely on the left temple by falling glass from a seventh-floor window. She complained of loss of memory, confusion of thought, and complete inability to sing or play the piano. She could remember ordinary matters well enough, but found herself utterly unable to read a single note of music or to recognise delicate shades of 120 THE MENTAL FUNCTIONS OF THE BRAIN intonation. At the time of the injury there had been a good deal of swelhng and bruising over the left temple, but no fracture anywhere. Extreme tenderness continued. The loss of memory for musical signs persisted for over a year. Case of Frontal Lesion — Aphasia — Musical Sense Preserved. BERNARD (" De I'Aphasie," Paris, 1889) : Lady music-teacher, age forty-five, had an apoplectic stroke, became hemiplegic on the right side and aphasic, but recovered the power of speech gradually, though she now expressed herself with difficulty. Yet she sang the tune " La dame blanche vous regarde " with the correct melody, pronouncing every word distinctly, and other tunes besides. She was not word-deaf. She could read a few sentences from a newspaper. She could read the title of music-scores, yet not the score itself ; she could not read a single note. Of all pieces of music put before her she could read the title, but failed with the notes. Post mortem, a long strip of the convolutions within the Fossa Sylvii was found destroyed. Case of Frontal Lesion — Aphasia — Musical Sense Preserved. FINKELNBURG (" BerUner Klinische Wochenschrift," 1870) : A professional violin player, after an apoplectic stroke, lost considerably the memory of names of objects, and more so of abstract ideas. He could still play the violin by ear as ably as before, but not from notes, which he constantly mistook ; nor could he write notes any longer without making mistakes. Another stroke deprived him of speech altogether, of the power of writing, and of the ability to read notes. Post mortem, the cortical layer of the island of Reil and the neighbouring parts were found softened. Case of Frontal Lesion with Loss of Musical Faculty. FRANK HAY (" Journal of Mental Science," vol. xii.) : Patient, a musician, suffering from epilepsy, became aphasic, and lost the musical faculty as well. He could not be induced to sing, though formerly a member of a church choir. His humming and whistling were only in a monotone, and never in the nature of a tune. The autopsy revealed the tip of the temporo- sphenoidal lobe disorganised, and exposed a cavity which entered the fissure of Sylvius, and laid bare the insula and anterior extremity of the operculum. Case of Temporal Lesion with Sensory Aphasia and Tone Sense Preserved. LUDWIG BRUNS (" Allg. Zeitschrift f. Psychiatric," 1892) showed at the meeting of the German Alienists at Hanover on May ist, 1891, the brain of a musician with sensory aphasia who had not lost the tone sense. There was soften- ing of the first temporal convolution with the exception of the anterior part. CONCLUSION This concludes the evidence in favour of the view of the frontal lobes being the material instruments for the manifestation of the intellectual capacities. In suc- ceeding chapters will be shown the functions of the otherlobes of the brain, concerned with the emotions and propensities. Therefore the inference may be drawn that no other part of the brain is involved in the intellectual functions, which we have enumerated. Nothing more is claimed for the view here expressed than that of an hypothesis. That it is one deserving the closest investigation there can be no doubt. The reader will remember the orthodox view of physiologists, which has been examined minutely in Chapter XX., and will consequently not be surprised to be informed that CH. CHATELIN and T. de MARTEL [op. cit.), in their report on 5,000 wounds of the skull and brain in the recent war, have come to the conclusion that " thtre are no symptoms special to wounds of the frontal lobes." (p. 51). They INTELLECTUAL OPERATIONS AND THEIR CEREBRAL ORIGIN 121 declare that the theory, so long maintained, " that the frontal lobes are a very important centre of association and the seat of the highest psychic functions " is "a purely theoretical assumption" and "has never received the slightest ex- perimental confirmation." In other words, because experimenters have failed to dig out any thought or sentiment in vivisected monkeys or dogs, therefore the frontal part of the brain can have no such function. The authors mentioned quote Munk's localisation of "movement of the trunk muscles" and Sherrington's "lateral movement of the eyeballs " as experimental evidence of the functions of this part of the brain, neglecting the fact that the extraordinary size of the frontal lobes in man is a characteristic which distinguishes his brain from that of animals, and the relation of " mind " to brain. Since localisation of special perceptions, individual memories, and other in- tellectual functions — as the evidence contained in this chapter tends to prove — is not admitted by present-day scientists, it is not surprising that no inquiries are made regarding the loss of them in lesions of the brain. Owing to this neglect, our knowledge of the mental functions of the brain — and the prevention and treatment of mental disorders — is still very primitive, as compared with the knowledge gained in other departments of science ; and no progress can be made so long as physicians and surgeons rely too exclusively on knowledge based on the results of experiments on animals. Dr. RICHARD EAGER, of Lord Derby War Hospital (" Journal of Mental Science" April 1920), states that of the 5,000 cases of head injury passed through his hands only 0'375% became insane. In his opinion most of the cases were purely "functional." Notwithstanding the large material at his disposal, he could quote only 28 cases of frontal injury^, and he concludes from these that "there seems to be no uniformity in the psychic symptoms that may follow frontal injuries, and the tendency that there has been in the past to consider as a special characteristic of injuries in this region the likelihood of the moral character of the individual to suffer most is not supported." He found, however, "the number exhibiting states of complete dis- sociation, such as amnesias, to be comparatively high." Though Dr. Eager mentions my researches, he gives no evidence that he examined the patients psychologically on the Unes indicated by me, and, so long as this is not done, reports w^ill continue to be published making it appear that, no m^atter how serious the injury to the brain may be and whatever the locality that may be affected, no mental change will follow. I repeat the question. What, then, are the mental func- tions of that organ in the opinion of these observers ? CHAPTER XXX THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN Intellectual functions have from time immemorial been associated with the brain ; not so the feelings. Yet whether we assume that they arise through external stimuli, through bodily sensations, or through ideas of our owti communicated to us, each rudimentary feeling — if there is anything like order in the nervous system — must have a centre in some group of nerve-cells from which it can set the rest of the brain into activity and produce its bodily manifestation. This has been recognised from time to time by individual observers, who located a general region for feelings in the lower ganglia of the brain ; but the idea of cortical centres is still thought absurd. Now, I propose to take in this chapter the feeling of fear and to demonstrate its centre of origin in the cortex. I choose fear, first of all, because it is a rudimentary feeling ; and, secondly, because it is easily demonstrated by the mass of evidence we possess of its morbid manifestation in circumscribed injury and disease of the brain, giving rise to that state of insanity called melancholia, which will be shown in Chapter XXXIV. to have at its base undue anxiety and fear, apparently without cause, or at least with insufficient cause. It has been shown in the previous chapter that the intellect is related to the front part of the brain, and that over-stimulation of the frontal cells produces a state of mania and exaltation, and that softening of the same part leads to dementia. The conclusion is perfectly natural that the other lobes of the brain must have func- tions different from those mentioned ; and since we must exclude the intellect, we must assume that they are related to the primary emotions and propensities. That the functions of the anterior and posterior parts of the brain are different in nature is partly confirmed by the pecuharity of the blood supply to the brain. As regards the blood supply, the brain is divided into two areas : (i) the anterior, fed by the internal carotids, and (2) the posterior, fed by the basilar artery, the union of the two vertebral arteries. The existence of the circle of Willis has done much to give us false impressions as to the amount of inosculation in the intracranial circulation. The existence of necrosis after embolism tells us very clearly of the shght character of the inosculations of the terminal vessels in the substance of the brain ; while the occurrence of hemiplegia after hgature of one carotid artery reveals the inadequacy of the circulation through the circle of Wilhs to maintain the functional activity of the half-hemisphere whose direct blood supply has been interfered %vith. These two vascular areas contain brain-cells with different properties and functions. The anterior and posterior parts of the brain appear also to differ in their influence on the nervous system. The former is connected chiefly with the voluntary or cerebro-spinal system, the latter with the sympathetic system. In other words, the anterior part of the brain seems to be exercised chiefly in connection with peri- pheral and muscular sensations and volition — with the relation of the organism to its surroundings ; the posterior seems to receive mostly internal, organic sensations, i.e., to be connected with the vegetative life. The distance between the brain and the viscera, between mind and appetite, is THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 123 bridged by the sympathetic nervous system (also called " ganglionic "), which plays such a large part in all the great vital processes as well as in the creation and modifi- cations of the emotions. It is only slightly under the control of the will, mostly act- ing reflexly to prepare the body for spontaneous protective action. That is how the actual origin of the passions has been placed in the viscera. As a matter of fact, the viscera stimulate the brain to emotional acts, by means of the sympathetic nerves ; and emotions can stimulate the viscera through these same nerves. It has been shown in the previous chapter that the pleasurable passions are connected with the front part of the brain. In this chapter it will be shown that the depressing emotions are connected with the posterior part of the brain. When, owing to some stimulus, the bloodvessels of the brain are dilated, a state of hyperaemia supervenes, producing a state of exaltation, so long as mild ; and, if severe, anger may follow. Just as a little alcohol quickens the circulation and makes us joyous and light of spirits ; a little more, and the temper quickens, and argumentativeness and quarrelsomeness may follow. Ordinary voluntary activity (of the cerebro-spinal system) causes a general expansion of vital action. The blood, under the animating influence, flows more hberaUy to the surface, and, playing freely through its capillary vessels, the counten- ance becomes expanded, its expression brightens, and the whole surface acquires the ruddy tint and genial warmth of health. The body also feels buoyant and lively, and there is a consequent disposition to quick and cheerful muscular action : to run, to jump, to dance, to laugh, to sing ; in short, every function would seem to be gladdened by the happy moral condition ; the common expression, therefore — the heart is light, or leaps wth joy — is not altogether figurative. A stimulus which dilates the visceral vessels, through the sympathetic nerves, causes paleness of the brain by emptying it of blood, and consequent depression, mental and physical languor, and, if severe, gloomy thoughts and fear. Under the active influence of the depressing emotions the whole body appears, as it were, to shrink or contract. The blood abandons the surface, and being thus thrown in undue quantity upon the internal organs, there follows that inward oppression, that painful sense of stricture and suffocation, and the consequent desire for fresh air which ever mark the intensity of this class of passions. Hence the frequent sighing under severe grief, which act consists in a deep inspiration, suc- ceeded by a corresponding expiration, and so, by expanding freely the chest and affording a larger supply of air, relieves, in some measure, the heart and lungs of their suffocative load. The painful passions also act immediately on all the vital functions, directly depressing all their energies. Although, however, the general effect of the painful emotions is to induce a contraction and a depression of the actions of life, yet, in their exaggerated forms, they are sometimes followed by a transient excitement, reaction, or vital expansion. This has probably some con- nection with a change in the emotions, as when the animal that took to flight from fear, when driven into a corner, gets into a rage and fights with all its might. The vaso-motor nerves of these two areas of the brain — the anterior and posterior — are also differently derived. The vaso-motor nerves of the vertebral arteries spring from the inferior cervical ganglion, into which run the fibres ascending from the abdomen by the greater splanchnic nerve. Indeed, ELIAS CYON (1843-), pupil of Claude Bernard, and ALADOFF, have traced nerve-fibres from the liver up the vertebral arteries. On the other hand, the carotid arteries derive their vaso-motor supply from the middle and superior cervical ganglion. Thus we can see how the emotions sympathise with the organic processes, especially those located in the abdomen, and can com- prehend how mental depression may accompany, or wait upon, and depart with abdominal disturbance, which does not extend to the intellectual processes, but involves the emotions alone. 124 THE MENTAL FUNCTIONS OF THE BRAIN The emotions are the mental interpretation of physiological adaptations for survival, for they are capable of calling up certain powers of the body into action which help to preserve the individual. One may tutor one's face and tongue to assume a condition consonant with one's surroundings, but the gloom or gaiety — the feeling or tendency to feeling — persist, in spite of everything. Can one fancy the state of rage and picture no ebullition of it in the chest, no flushing of the face, no dilatation of the nostrils, no clinching of the teeth, no impulse to vigorous action, but in their state limp muscles, calm breathing, and a placid face ? What kind of an emotion of fear would be left, if there were not present the feelings of quickened heart-beats, shallow breathing, trembling lips, weakened limbs, sensations of goose-flesh or of visceral stirrings ? But the bodily state may be both cause and efiect of the emotion. For example, the sight of danger causes us to fear, and an anaemic condition of the brain may also cause a vague fear. It has been supposed that each emotion has some special organ or organs on which it- power is more particularly expended ; that some act most obviously on the heart, as fear and joy ; others on the respiration, as surprise ; and again others, as grief, on the digestive organs. We shall find a clear indication of this connection in our common forms of speech, which must have been derived from observation and generally recognised before they could have been incorporated with our language. The paleness of fear, the breathlessness of surprise, and the bowels of compassion, are phrases sanctioned by the custom of different ages and nations. The effects of a passion, however, are rarely limited to a particular one, but a number of the organic viscera are almost always included within their influence. The viscera do not distinguish between different kinds of emotion, but the different emotions have their own bed or track dee'ph'^ laid already and ingrained in the central nervous system, and each has in connection with this track a separate group of co-ordinating neurones. This is the view expressed by Prof. SHERRING- TON, the distinguished physiologist, with which I not only agree, but which I shall attempt to prove in this and succeeding chapters. Those who hold that the origin of the specific emotions cannot be localised, in the brain advance as a reason that each emotion tends to involve nearly the whole brain and bodily organisation ; but, as I have already explained, this is judging by the effects of the emotion. By observing the effects of circumscribed injury and disease of the posterior parts of the brain — and comparing them with the effects of circumscribed injury or disease of the anterior — it will be seen that the two have different functions. In this chapter I propose to limit the inquiry to the functions of the central parietal area, which will be shown to be affected in states of depression and melancholia, which have fear, either vaguely or definitely, as their basis. True, fear can stimu- late as well as inhibit the entire organism, according to its degree ; but so can anger, a totally different emotion. Common sense will tell us that they must have different centres of origin, from which their influence is directed. But it is not by arguments that I intend to prove my statement, but by evidence. The view that the central parietal area is concerned with the highest intellectual operations, and Flechsig's view that it is the centre for musical ability, have been disposed of in previous chapters. On the other hand, the current theory (of cerebral physiologists and pathologists) that lesion of this area gives rise to " psychical blindness " (see Chapter XX.) is not opposed to the localisation about to be proved ; on the contrary, a number of examples will be cited of concurrent symptoms of fear and psychical blindness. We have seen that in lesions of the frontal lobes there is usually a feeling of THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 125 physical well-being and mental exaltation. The evidence that follows will show that in lesions of the posterior part of the brain (the area behind the central fissure) — or, more clearly defined, the central parietal area — there is generally a feeling of being physically unwell and mental depression. At the basis of simple melancholia is the emotion of fear — an unreasonable ap- prehensive depression, which retards thoughts and movement, and interferes greatly with self-control, without impairing the reasoning power. Whereas joyful emotions accelerate the course of ideas, anxiety, fear, grief, and all depressing emotions inhibit intellectual processes. The intellect remains intact, but as every exertion augments the distress, such patients avoid all occupation, become inert, indecisive, and brood over their own sadness. The intellect is not equal to the task of con- trolling these gloomy thoughts. Melancholia is a morbid condition of the emotional life affecting a brain area which is not concerned in intellectual processes. These only get slower, painful, and restricted to the patient's own woes. (See Chapter XXXIV.) Were melancholia an affection of the entire brain, the intellect would always be involved ; whereas one may meet every day with melancholiacs who do not exhibit any disorder in their ideas or judgment. Simple melancholia is essentially a state of mental pain, a vague feeling of anxiety, gloom, depression, indifference to the ordinary interests of life, and lack of all hope in the future, or positive fear and trepidation. Those who suffer from it labour under an indefinite despondency, which they can neither shake off nor explain. They find no pleasure in anything, nor can they be touched by the misfortunes of others, their own distress being much more intense than all besides. Thus they live in constant soUtude and apprehension. Fear and apprehension shade and modify the reminiscences of the past, exaggerate dangers, and distort reality. Thus a just and rational view of life is no longer taken. The subject is generally acutely conscientious and distresses himself needlessly with worries, of which the unreasonableness is appreciated by him but cannot be got rid of. Other feelings are paralysed, consequently the patient becomes indifferent towards those persons and things which he used to hold in affection. The feeling of fear is so accentuated that any trifling mistake ever made is exaggerated and self -accusations follow, which, however, are not delusions, but simply reasons to account for the depressed feeling and state of anxiety. The patient, as the disease progresses, anticipates dreadful consequences of his past errors ; he is therefore unhappy, sleeps badly, weeps, sobs, sighs, groans, laments his cruel fate, and wishes to be dead. Suicide is common. The physical manifestations of uncomplicated melancholia are identical with the manifestations of fear. They both produce a state of anaemia through vaso-motor spasm, which causes pallor of the face, cold extremities, and praecordial distress. The contraction of the coats of the arteries causes a rise of blood pressure. In mania the blood-pressure is lowered ; in melancholia it is increased. WTiereas the average blood-pressure in a normal man is 152mm. Hg., and in cheerful people it falls to 145 or 140 mm. Hg., in anxious patients it rises according to the degree of fear to as much as 180 mm. Hg. The tension of the walls of blood-vessels is increased so that they admit only of a small quantity of blood from the heart, which has therefore difficult work to perform, and thus gives rise to painful sensations. A profuse shedding of tears relieves the blood-pressure and reUeves also the mental state. This is the reason why grief and anxiety can be worked off sometimes by a good fit of crying. JOHN TURNER (" Journal of Mental Science," 1909), however, says there is no relation between blood-pressure and mental disorders. Fear and the anxious emotion, if prolonged as in the state of melancholia, cause defective nutrition, and this defect is particularly manifest in those parts of the human frame supplied by the sympathetic nervous system. The skin becomes dry and muddy in appearance, the hair is also dry and harsh, fades in colour, turns grey, 126 THE MENTAL FUNCTIONS OF THE BRAIN aad may fall out altogether ; the nails grow slowly ; digestion proceeds slowly, leading to discomforts and disturbances which later may give rise to various delusions ; the bowels are constipated ; the bodily temperature is lowered, the pulse is slowed, and so is practically every bodily process. Owing to the deficient breath- ing, lung disease is the most common termination of melancholia. Fear and melancholia render the cerebro-spinal nervous system inactive, hence the muscular languor, lassitude, and loss of all sense of energy. There is frequently a condition resembling what is called " apraxia," namely, an inability to execute the movements required to carry out a definite action, although there is no paralj^is. This muscular inability is acknowledged to take place in lesions of the parietal lobe. An erect figure is never seen in this malady. As in an acute state of fear, so in acute melancholia, the subject may remain fixed in one attitude ; in another degree he may be restless, but this restlessness is brought about by the involuntary nervous system, and is quite different from the maniacal restlessness which originates in the voluntary or cerebro-spinal nervous system. The trembling of fear is probably due to the rhythmic action of the sympathetic nervous system on the cerebro-spinal nerves. In melancholies, not only is what little movement that takes place done rhythmically, but the words uttered — the expression of their misery — is repeated in a rhythmical manner. Whereas insanities in which the cerebro-spinal system is involved — such as acute mania and epileptic insanity — can occur suddenly, melanchoUa involving the sympathetic system is slow in its onset. The beginnings are usually so slight that they attract no notice, and it is not until the disorder has become fully established that it is remembered for how long the symptoms have been gradually increasing. Pure melanchoUa being an emotional and not an intellectual disease, it is not surprising to discover that JULIUS JENSEN (1841-1891) " Archiv fiir Psychiatrie," vol. XX., who examined 453 brains of insane patients, found that in melanchoUa the frontal lobes are not involved, and that W. J. T'lGGES (1830-), " AUg. Zeitschrift flir Psychiatrie," 1888, made the same observation. The latter said : " In melan- cholia there is no wasting of the frontal lobes — they retain their weight ; in mania, there is some loss of weight ; in general paralysis the loss is the greatest." This view was also expressed long ago by the celebrated J. L. C. SCHRODER VAN DER KOLK (1797-1862), in his text-book on "Mental Disorders" (1852) : "In insanity proper, in cases of confusion of ideas, and of insanity of exaltation, I have always found the anterior lobes of the brain suffering ; but, on the contrary, in the melancholic, and in those who condemned themselves with or without religious delusions, I have found the upper and posterior parts of the hemispheres diseased, and that in the latter cases the understanding often showed no trace of disturbance, inasmuch as the individuals judged correctly and disputed acutely. In those who at last perished with dementia, I never found the anterior parts of the obes intact ; they were alway adherent to the pia mater, and this could not be removed without injuring the grey cortex." J. A. LOCKHART CLARKE (1817-1880) has said : " That the anterior and posterior lobes have different functions is certain, as the convolutions of the cerebral regions have different structure." AUG. VOISIN read a paper on "The Suicidal Tendency " to the Academy of Medicine on August 8th, 1882, in which he declared that his observations led him to the conclusion that the particular part of the brain which gave the tendency and impulse to suicide is in the parietal lobes. CHAS. K. MILLS ("Philadelphia Medical Journal," i90i)held that cerebral tumours in parietal region render patients abnormally emotional. BERNHARD GUDDEN (1824-1886) declared the anterior half of the brain to be concerned with motion, and the posterior half with sensation. LUIGI LUCIANI (1842-1919) and GIUSEPPI SEPPILLI were of opmion that the fusion of sensory centres takes place in the parietal lobes. THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 127 FRANCESCO DURANTE saw in the posterior lobes the centre for general ensi- bihty, and behaved them to be involved in melancholia. ALBERT E. EULENBURG found by experiments on dogs that stimulation of the parietal region produced irritation of the vaso-motor nerves, together with such symptoms as sudden emptying of the bowels, which we frequently observe in fear. F. L. GOLTZ (1834-1902) and BEATSON found that destruction of the posterior lobes in dogs and sheep causes these animals no longer to be frightened by objects that had caused them terror previous to the operation. Dogs which were lively and active before the operation became quiet and apathetic, and their intellect was inhibited. JAC. MOLESCHOTT (1822-1893) noticed that immediately after destroying in pigeons that portion of the brain corresponding to the parietal lobes in man, they showed a total imperception of danger. Sir DAVID FERRIER observed that : "The animal whose left angular gyrus was destroyed moved only unwillingly, and when it was obliged to ; it ran its head full tilt against everything that came in its way. When both angular gyri were destroyed there was still greater reluctance to move from its position, arising evidently from a sense of insecurity, for the animal paid no attention to threats and grimaces. HERMANN MUNK also observed " non-perception of threatened danger — the animal made no sign of fear at threatening gestures." HEINRiCH KISCH stated as most characteristic symptom of mental depression a sensation of heat about the parietal bone. R. V. KRAFFT-EBING (1840-1902) considered melancholia a form of neurosis or psychical neuralgia of the sensory centres of the brain. Undoubtedly, melancholia gives rise to a psychical hyperaesthesia. THOMSEN and OPPENHEIM (" Archiv f. Psychiatric," 1884) stated that the sensory anaesthesia form a typical group of symptoms, the most constant being the bilateral concentric limitation of the visual field. It is important to observe that in almost every case psychical symptoms are present ; most often depression of spirits, feelinss of apprehension, and easy excitement to terror. GALL described the physical movements appropriate to this area as that of circumspection, taken literally : " Turning the head sometimes to the right, some- times to the left, holding it slightly inclined backwards, while the eyes, wide open, follow the movements of the head." The locality and description have been un- consciously confirmed by FERRIER, who, in stimulation of his Centre 13, observed : " The eyeballs move to the opposite side, and frequently also the head moves in the same direction." It is also well known that in melancholia there is anaemia of the brai^, and in mania hyperaemia ; and that hallucinations of sight are common in anaemia, whereas hallucinations of hearing occur in hyperaemia. There is ample material to prove to us the relation of melancholic states of mind to pathological conditions of the parietal lobes, more particularly of the angular and supra-marginal convolutions. Numerous examples will be given, but to remove any doubt which may obscure the judgment in the testing of these cases it is advisable to explain at once those exceptions in which lesions have been found in other regions than the parietal. Everyone may call to mind cases of melancholia which were found with lesions of the frontal lobes. How are these to be explained ? In the previous chapters it has been shown that the frontal lobes are the centres of the intellect, and as such they are the centres of inhibition of the emotions. In a lesion of the frontal lobes, therefore, the control or inhibitory influence exercisable over the emotions would be lost, and thus naturally active dispositions become morbid. Of course, if the patient is demented as well as melanchoUc, both parietal and frontal convolutions will be found affected. Sometimes no lesion may be discoverable, and sometimes the whole brain may 128 THE MENTAL FUNCTIONS OF THE BRAIN apparently be affected. Thus we may find a general anaemia of the brain in melan- cholic cases owing to inanition. In such inanition-melancholias there prevails an intensification of the natural characteristics of the patient ; there is manifested a hereditary or acquired disposition to a depressed condition. The same would be true where the blood is the carrier of toxins. In all these conditions, only dispositions which are already leading and highly active in the normal state will become morbid. Thus the modest, humble, ap- prehensive, and conscientious man becomes the melancholiac and self-accuser. Persons who are of selfish and criminal cast of mind do not in their delirious utter- ances reproach themselves, nor express ideas and sentiments which imply that they are especially troubled about their past conduct. The delusion that they have committed the unpardonable sin afflicts only the meek, humble Christians who cherish ideas of exalted purity, and who long to attain a holiness of life, yet distrust their capacity, wisdom, and self-control ; and are thus led to safeguard anxiously their motives, search their hearts for lurking inclinations to sin, and so drift on into the unfathomable abj^ss of morbid introspection, which naturally ends in insanity. The ungodly, who pursue deliberately lawless, wicked ways, without a pang of regret, do not become self-incriminating the moment thought and reason are unrestrained. It is not the dishonest man, the gambler, or the thief who will, while delirious, confess himself guilty of cheating, embezzlement, and financial frauds ; but rather the kind-hearted " Golden Rule " man, who has endeavoured to practise just and upright dealings with all men, and whose generous promptings often have exceeded his means of benevolence. The clinical material which we are about to produce shows that the supra- marginal and angular gyri are concerned in the production of those morbid psychical and physical states which we collectively term " melancholia," of whatever nature the lesion may be. Frequently the functions which have been assigned to this area by various physiologists and neurologists, such as "psychical blindness," exist with melancholia, particularly in its earher stages. Such earlier stages, however, do not often come under the observation of aUenists ; and the neurologist, generally speaking, is not wont to notice the mental changes in the patient ; or, if he does ob- serve them, he is likely to regard the patient's depression, anxiousness, and morbid fears as the outcome of existing physical trouble and not of the particular lesion of the brain. I am aware, of course, that by a great many alienists melancholia is no longer regarded as an independent psychosis ; that it has been shown by GEORGE DREYFUS that all of the cases described by KRAEPELIN and his school as " melancholia simplex," "melancholia agitata," and "depressive insanity," are in reality cases of manic-depressive insanity. Dreyfus found in a large number of the cases he examined typical circular symptoms. But this only shows that in manic-depressive insanity we have a general affection of the brain, probably of its circulation ; and with cases involving the whole brain, or the greater part of it, we are not concerned in this book. Sir GEORGE SAVAGE had already pointed out in 1887 that melan- cholia might usher in mania or general paralysis, or be present after an attack of mania as a phase of reaction, but that it is also true — as may be seen by the examina- tion of the cases I am about to quote — that melancholia may be a complete psychosis in itself. That, after the disorder has lasted some time, the melancholic state may change into something else is no proof against my view, since the cause may be in a circulatory disturbance which cannot be strictly limited ; and, even when it is in the brain itself, it may be of such a character that the mischief cannot remain limited to a particular region for any length of time. Besides cases of tumours, inflammatory lesions, haemorrhages, etc., I shall cite cases of injuries to the brain which have been followed by the manifestation of melancholia. These cases of injury to the parietal region, when compared with the cases of injury to other regions of the brain which I quote, will make it evident THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 129 that there is no ground for a "traumatic insanity," as various authors have assumed. A single form of traumatic insanity is simply non-existent. SKAE, MAUDSLEY, and others have declared that melanchoUa is rarely present in trau- matic insanity, but the cases I shall quote show that injuries to the middle parietal region are always likely to be followed by mental depression, morbid fear, anxiety, and actual melancholia. In order to demonstrate the practical value of this locaUsation, I shall begin with cases of melancholia which have been cured by surgical operation. SURGICAL TREATMENT OF MELANCHOLIA One of the author's own cases of Parietal Injury followed by Symptoms of Melancholia — Surgical Operation — Recovery. {Published in " Lancet," 1907.) Patient, age thirty-nine, a doctor of medicine, previously quite healthy, fell from his cycle on his head. He did not think that he had received any marked injury, and did not believe there was any connection between his subsequent illness and the accident. There certainly were no external signs, but soon after the accident he began to suLfer from hemicrania so severely that he could not go on with his work. He got depressed, anxious without sufl&cient cause, accused himself of all sorts of evil deeds without foundation, and made some attempts on his hfe, so that he had to have a companion to watch him. He consulted various speciaUsts, who advised change of scene ; but travelling did him no good. The depression and headache increased. He consulted the author six years after the accident, and was then melancholic, emotional, readily weeping, and very suicidal. The right side of the head pained him much, and there was a burning sensation just behind the right parietal eminence. Operation was proposed, which Mr. William Turner carried out. Only when the head was shaved did a scar become visible, which extended from the situation of the angular convolution just behind the parietal eminence vertically downwards for about two inches. A semi-circular flap was made extending from the ear to the occipital protuberance, and the scar, which was adherent to the bone, was detached. Two trephine openings, one one inch and the other eleven -six- teenths of an inch in diameter, were made and connected with one another. The bone over the angular convolution was thickened and ivory-hke, without any evidence of diploe, and the dura was attached to the bone. The brain bulged into the wound and did not pulsate, notwithstanding a strong pulse at the time. On incision of the dura a stream of clear fluid escaped. The dura was found thickened, but the brain appeared quite normal. Dura, periosteum, and flap were each closed with stitches, only a small opening being left for drainage for some days. Patient was at once free from pain and of cheerful, normal disposition, and after two years of perfect health gave permission for the pubhcation of his case. Other cases vf Parietal Injury — Melancholia — Surgical Operation — Recovery. G. IVIACKENZIE BACON (" Journal of Mental Science," 1881) : Samuel S., age thirty-eight, joiner by trade, always in good health. Whilst at work a hammer fell from a height of about six feet on his head. He was not un- sensed, nor were any serious symptoms exhibited at the time of the accident ; but six months afterwards he found himself unable to attend to his work through giddiness and inability to fix his mind on anything. A year after the accident he complained of severe pain over the stellate and adherent cicatrix on the left parietal bone. He grew morose and talked of suicide. In the following month he made a most determined attempt at suicide by throwing himself from the staircase at the top of the hospital where he was then an inmate. His life was saved, and he was sent to Fulboume Lunatic Asylum. An operation was arranged, and Mr. Wherry removed with the trephine from the seat of the injury a piece of the parietal bone, and found the dura mater beneath of a deep purple colour, and apparently healthy ; it bulged with pulsations into the wound. The portion of the skuU removed was three quarters of an inch in diameter, but had not been fractured. The wound healed rapidly and well, and a month later the patient was Uvely and cheerful and Vol. ii.] K 130 THE MENTAL FUNCTIONS OF THE BRAIN went to work in the carpenter's shop. Three months after the operation he went back to his old employers. He continued in good health. GEORGE E. WHERRY ("British Medical Journal," 1883) : N., an attendant of the Three Counties Asylum, a strong man, age 25, was sitting in an arm-chair, when a powerful lunatic came up from behind and struck him on the head with a heavy carpenter's mallet. He remained master of his senses, but fainted from loss of blood. There was a compound comminuted fracture of the right parietal bone, from the parietal eminence to the sagittal suture. He was trephined. The inner table was found more extensively fractured than the outer, the fragments of skull being deeply depressed and the brain bruised. The exfoliated bone was removed. Next day the wound unfortunately suppurated. The patient, who, previous to the operation, was merely anxious about himself, otherwise calm and intelligent, got more depressed and suUen, and in another month was insane. He had a vacant and absent look. More pieces of bone which had been exfoliated were removed, after which operation he spoke rationally, and by December recovered sufi&ciently to engage in farming pursuits. WILLIAM MACEWEN (" Lancet," 1888) : A man who had received an injury to his head a year previously suflfered from deep melancholy and paroxysms of pain in the head. Though the pain was ex- cruciating he welcomed it, as it temporarily dispelled the almost irresistible impulse to kill his wife and children. Prior to receiving this injury he was perfectly free from impulses of this kind and had led a happy life with his family. Immediately after the ac-cident, and for about two weeks subsequently, he had suffered from psychical blindness. Physically he could see, but what he saw conveyed no im- pression to his mind. This gave the key to the operation. The angular gyrus was exposed, and it was found that a portion of the internal table of the skull had been detached from the outer, and had exercised pressure on the posterior portion of the supra-marginal convolution, while a comer of it had penetrated and lay embedded in the anterior portion of the angular gyrus. The bone was removed from the brain and re-implanted in proper position, after which he became relieved in his mental state and made no further allusion to his muirderous impulses. The SAME AUTHOR (" Pyogenic Infective Diseases of the Brain," 1893) : J. W., age twenty-five. Seven weeks prior to admission he fell down the slope of a quarry, his head coming in contact with a projecting stone. In this way he received a small wound at the posterior extremity of the left parietal bone, about one inch from the middle line, which gave him little trouble and was soon healed. About three weeks after the accident he began to experience a dull aching pain, and began to suffer from great mental depression. These symptoms continued until his admission into the hospital, four weeks from the attack. At the operation the periosteum was found to be thick and somewhat inflamed. A stellate fracture of th? skull was discovered, with a much depressed and comminuted internal table, and about four drachms of pus escaped. At the centre of the affected area the dura mater was covered by a thick layer of granulation tissue, while at its circumference this membrane was flocculent. A fortnight after the operation the wound healed. The patient's former mental depression and painful sensations had entirely dis- appeared. A month later he was dismissed well, and twelve months after he reported that he was in excellent health and attended to his work regularly. W. B. FLETCHER ("American Journal of Insanity," 1886-1887) : W. P. H., age thirty-five, fell from a scaffolding six years prior to admission, and exhibited since then strong suicidal tendencies. There was a depression of bone in the left parietal region, near the osculation of the right parietal and occipital. The depression was quite perceptible to both sight and touch. The depressed piece was elevated and, according to Dr. Fletcher, the patient " found to his deUght that he was free from pa n and from the abnormal mental condition, which had been his constant companion for years, since the moment of his fall from the housetop." The SAME AUTHOR {ibidem) : J. G., age forty-seven, machinist, was struck on the head by a stove-Ud lifter three years before admission. He was taken home in an unconscious condition, and so remained for six hours, and confined to his bed for several days. He was soon able to resume work, which he continued to do, after a fashion, for six months. THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 131 From this time on he became negligent, caFeless about his clothing, with lack of interest in anything ; finally melancholy and suicidal. Careful examination under chloroform revealed a scar on the parietal bone one and a half inches from the coronal suture. The scalp was adherent. On dislodging the surrounding bone, a spicule of the internal table was found, puncturing the dura like a carpet-tack. By the seventh day after the operation the patient was a " new man," as he expressed it. He has been able to continue his work as a stove-moulder from that time, and was reported two years after his discharge as being still perfectly well and working at his trade constantly. The SAME AUTHOR {ibidem) : Henry Stevens, age twenty-three, was admitted to hospital from prison for melancholia. He never talked nor moved, and sat constantly with eyes turned downwards and lids nearly closed, as if to avoid the hght. A scar ran from the coronal suture backwards over the left parietal bone, two inches long and one inch wide. The bone was depressed to a corresponding extent, and was removed. The melancholia disappeared. He talked, walked, and cared for himself. But another injury — possibly by contre-coup — was supposed, as patient became later morose and profane. The SAME AUTHOR (ibidem) : M. C, age forty-four, was injured by a fragment of bursting shell, and suffered from melancholy ever since. There was a deep scar, one and a half inches long, vertically over the centre of the left parietal bone, forming a groove in the bone. Though there was no depression of bone, the patient's pain and nervousness dis- appeared after the operation, and he became cheerful and went to work as a gardener. The SAME AUTHOR (ibidem) : J. N., age fifty, fairly educated, and, for a farmer, had accumulated a good fortune. Eight years prior to admission he was standing in a saw-mill, when the boiler exploded, a fragment of iron striking him on the upper and anterior third of the right parietal bone. Through this he was unconscious for several days, but gradually recovered, and for seven years pursued his occupation on the farm. Then he got muscular convulsions of face and arm, and at the same time became melan- cholic, listless, and sometimes suicidal. His friends wanted him committed to an asylum, but an operation was decided upon instead. There was no fracture at the seat of injury, but the dura was firmly adherent to the bone ; it was tough and did not pulsate. On incision two drachms of fluid escaped, and during the next forty- eight hours a large quantity of yellowish fluid. All symptoms disappeared and patient has been well ever since. The SAME AUTHOR mentions other successful cases and two unsuccessful ones. These two had suicidal tendencies after injury to the frontal bone, and trephining the depressed portion of bone, over seat of injury, did not improve the patients. I have already pointed out that the frontal region is the inhibitory region, so that lesions thereof are liable to accentuate natural tendencies : a naturally gloomy man becoming melancholic, an irritable man bad-tempered and violent, and so on. Hence the importance of the mental symptoms for localisation. There is also the possibility of contre-coup. P. STETTER (" Centralblatt fiir Chirurgie," 1892) : Patient, age twenty-eight, received an injury some eleven years before in consequence of a cart-horse, on which he rode, shying at a railway train and throw- ing him to the ground. The pole of the cart was driven into the lower part of his right parietal bone, and the depression extended to the parietal eminence. He was carried home unconscious. The wound healed rapidly, but the depression remained. No physical symptoms, but striking psychical changes. Patient shunned aU association with men, sat for hours brooding in a comer, had daily paroxysms of weeping, and in the end preferred his bed to getting about. He was trephined and the depressed bone was removed. After the operation patient resumed social life again and became quite normal. BRIGGS (" Philadelphia Medical News," vol. xiv.) : A similar case of a patient who was successfully operated upon five years after injury. 132 THE MENTAL FUNCTIONS OF THE BRAIN J. M. KOPPE, Halle a/S., (" Deutsches Archiv f. Klinische Medizin," vol. xiii.) : Christian Liese, when forty-two years of age, received a blow on the left parietal bone. Three years afterwards he betrayed much abnormal anxiety, developed S5rmptoms of melancholia, and the following year he made two attempts at suicide, one by hanging, and one by cutting his throat. He was sent to the asylum. At the seat of the injury a scar was visible, and a small tumour could be felt. On excision it was found to be a neuroma dolorosum. Patient became bright and cheerful, declaring himself free from pain, and was discharged. He reported himself some time afterwards as continuing well. The SAME AUTHOR {ibidem) : C. D., age eighteen, received a blow from a stick on the left parietal bone, which caused him great pain. Fourteen days afterwards, when the wound was healed, he became excited with fear, saw danger everywhere, looked anxiously about, sat or lay motionless. He was admitted to the asylum with symptoms of melancholia, and had to be forced to take his food. Wlien moved to speak at all he burst out crying. On the left parietal bone there was a highly tender scar, one inch long, adherent to the bone. The excision of the scar cured the patient, and he was discharged. DANIEL MOLLIERE (Report of the French Surgical Congress, 1885) : M. A., age forty-nine, received an injury in the parietal region close to the temporal bone, which left a scar of fifteen centimetres length. Patient became melancholic, with paroxysms of agitation at night. The operation revealed an abscess in the brain beneath the seat of injury. On letting out the pus, his recovery was rapid. He soon returned to his occupation, which he followed Avith his former gaiety of spirits, and he reported himself to the physician to have kept well and in possession of all his faculties. The SAME AUTHOR {ibidem) : H. X., age thirty-one, received an injury to his head which left a scar in the right parietal region. He became melancholic. After trephining the skull at the seat of injury he gradually improved, and was discharged two months after the operation, and reported himself well and working at his trade two years later. H. A. POWELL (" Surgical Aspect of Traumatic Insanity," 1893) : Depressed fracture of the right parietal bone in a girl age eight. Depression and apathy. Trephined seven years after injury, when fifteen. Became at once bright and cheerful. Under observation two and a half years. GEORGE W. CALE ("New York Medical Journal." 1895) : A carpenter, age twenty-six, always healthy until receiving a blow on the parietal bone to the left of the median line, about midway between the fissure of Rolando and the external occipital protuberance. Four years after, he complained of pain at the spot, and became melancholic, sullen and morose. The depressed bone was elevated. On recovery from the operation he was at once cheerful, and undertook again a responsible position. BOUBILA and PANTALONI (" Gazette des Hopitaux," 1892) : Case of a patient suffering from hallucinations of sight and tendency to suicide, which was cured after lifting up a piece of depressed bone in the posterior parietal region, evidently the result of an injury. FENOGLIO (" Bologna Ri vista CUnica," 1887) : Similar case. Operation. Complete mental recovery. An interesting observa- tion was made in this case, namely, that the symptoms were reproducible by pressure over the trephine hole. The SAME AUTHOR (" Archiv. di Psichiatria," 1884) : A young farmer, age nineteen, suffered a depressed fracture of the right parietal bone situated between the parietal eminence and the highest middle point of the temporal crest. The previously merry, cheerful patient fell into a sad and de- pressed mental condition, w^hich brought him to the asylum five years afterwards, in his twenty-fifth year. He was trephined, and a splinter of bone, which had in- dented the brain, was removed. After the operation the patient recovered his former bright nature. PHILIPPE REY ("Report of Alienist Congress," Lyon, 1891) : Patient, age forty, was admitted to the St. Pierre Asylum for symptoms of melancholia, distressing delusions, and terrifying hallucinations. There was a THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 133 depression in the left parietal bone, size five centimetres, about which no history could be obtained. The depressed bone was elevated, the dura mater excised. The meninges presented a gelatinous appearance with milky spots. After the operation the patient lost his depressing delusions and hallucinations. J. E. CHAMBERS (Report of Cosmopolitan Sanatorium, St. Louis, 1906) : Patient, age thirty-seven, sustained a fracture of right parietal protuberance two inches long. Part painful on pressure and caused fainting. Three weeks later he had " melancholia agitata " lasting for three and a half years. At the end of that time he was operated upon with such success that he was able to resume his occupa- tion after ten weeks. T. RIBOLI (" Phil. Seb.." vol. i.) : Female patient, suffering for four years from melancholia, complained of pains on the right side of the head. There appeared a swelling the size of a nut on the parietal bone. When it was cut open, pus escaped. But it re-formed, and the second time it was cut open by an accidental knock on the head. Then a necrosed particle of bone was discovered underneath. After its removal the melancholia disappeared, and patient having no relapse within a year of the operation, she was discharged. G. H. HUME ("Lancet," 1908) : The patient, a man between fifty and sixty years of age, fell from his bicycle and received a cut on the back of the head on the left side. He lay unconscious for a few minutes and came to himself standing in the midst of a group of workmen who had come to his assistance. The wound was dressed by a surgeon late in the day. It healed readily, and the ordinary habits of life and business were not interrupted. But from the date of the accident he felt vaguely ill and suffered from a constant feeling of anxiety and depression. He went on a voyage and wrote : "I must confess to a constant urging towards suicide ; it seems so easy to drop overboard in the dark and end all my troubles." He suffered from pains on the left side of the head. Three months after the accident he was trephined. The posterior parietal region was laid bare by a large flap reflected downwards. The cicatrix of the wound was included in the upper and posterior angle of the flap and the underlying bone showed no trace of injury. Three trephine discs were then removed and the intervening piece of bone was cut out. The exposed dura mater bulged and looked bluish, and when it was incised a quantity of porter-hke fluid gushed out to the estimated amount of five or six ounces. Adherent portions of the clot were scraped away, and while this was being done it was noticed that the surface of the depressed parietal lobe was slowly rising to the normal level. The dura mater was readjusted, and the scalp flap closed. The bone was not replaced. He recovered completely. H. HANDFORD ("British Medical Journal," 1899) : A girl, age thirteen, had atrophy of both optic nerves. She suffered from head- ache and melanchoha, and had visual hallucinations . There was an osteophite in the right parietal region, which on trephining was seen to have pressed internally. Patient after her operation lost her headache and hallucinations and became cheerful, and even her sight improved. MELANCHOLIA FROM PARIETAL INJURY Other Examples of Injuries of Parietal Lobes followed by Abnormal Fear, Anxiety, and Melancholia. Case of Recovery. CHARLES PHELPS (" Traumatic Injuries to the Brain," 1898) : Patient, age thirty, fell twenty-five feet from a ship's deck on to a raft alongside. Consciousness was lost for a few moments only. Haematoma over right parietal region. After three weeks painful delusions developed. He suffered acute mental anguish, which could have been scarce exceeded had these pure fancies been actual facts. An inclination to weep was manifested both with and without cause. His speech was always coherent. Gradual recovery. Discharged seven months after admission. 134 THE MENTAL FUNCTIONS OF THE BRAIN Another Case of Recovery. HAHN (" AUg. Zeitschrift f. Psychiatric," 1892) : Patient, a little boy age ten, was shown at the Fifty-fifth Meeting of the German Alienists at Breslau. He had received from his teacher a blow Avith a cane over the left parietal region. Five days after the receipt of the injury patient had a paroxysm of fear accompanied by trembling of all the muscles, painful sensations over the heart, and hallucinations inspiring great fear. He made self -accusations. Two da}^ later came delusions as to his going to be hanged. He regained his perfect mental stability after treatment. One More Example of Recovery. M. GAMBERINI (" Bulletine delle scienze mediche di Torino," vol. i.) : A banker, age thirty-four, with a history of syphilis, fell from a height on to the left parietal bone. He had severe headache subsequently, and epileptiform attacks, first slight, then growing in severity, and his mental state became that of melan- choUa. His expression was that of sadness and anxiety, and he had a fixed stare. The bone was swollen at the seat of injury. Anti-syphilitic treatment not only made the swelhng disappear, but cured the melancholia and epileptiform attacks. RATHMANN (" Vierteljahrschrift f. gerichtl. Medizin," Berlin, 1901) : T. S., age fifty-six, single, Catholic, always healthy, fell downstairs in 1891, and injured the right parietal bone. Since that accident she suffered from insomnia, aversion to food, deemed herself unworthy to receive the Sacraments, believed she was going to be executed, her head chopped off, etc. She spoke only in a whisper. Sighed constantly. She made a recovery and was discharged. Examples of Parietal Injuries followed by Symptoms of Melancholia. JOHN GAY (Medico-Chirurgical Society Meeting, November 25th, 1879 ; "Lancet," 1879) : Patient received an injury to the parietal bone, followed by necrosis. He was for the following five years despondent and suicidally inclined. He was brought into the hospital after an attempt to drown himself. He was to have been tre- phined, but cut his throat the day before the operation. At the necropsy the inner table was found driven in and adherent to the cicatrix through a fissure in the bone. The brain was normal, only slightly depressed under the indented bone. During life pressure over the cicatrix always caused hallucinations of the same type. JOHN F. GRAY (" American Journal of Insanity," 1876) : A soldier, age forty-one, was wounded in the head, the ball striking the posterior part of the right parietal bone, crushing it in, leaving an opening in the skull one and a half inches in antero-posterior diameter, and three inches in the vertical line. The ball was embedded in the substance of the brain, and was removed with forty-eight pieces of bone ten days after the injury. He remained in good health for five years, when he became depressed and finally developed profound melancholia. Post mortem, an elliptical opening of the right parietal bone was found, corresponding to the wound described ; the dura mater extended over the opening and was firmly adherent to the scalp. It appeared inflamed and thickened. Brain apparently healthy. C. J. ELLEFSEN (" Norsk Magaz. F. Laegevdensk," 1896) : Patient, age fifty-four, became melancholic after some heavy blows on the head . Post mortem, haemorrhage was found over the parietal region, compressing the convolutions. M. DINKLER (" Deutsche Zeitschrift f. Nervenheilkunde," Leipsic, 1895) : Katharine Laier, when two and a quarter years old, fell down ten metres over two flights of stairs, and hit the left side of her head on the stone floor. Was rendered unconscious. Since then mentally depressed, hyper-sensitive, suffering from night-terrors and polyuria. Two and a half years after the accident great terror one night, with trembhng, agitation, turning of eyes, severe headache and THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 135 vomiting. Collapse and death. The left parietal eminence showed a scar 6-5 centimetres long. The brain underneath was hyperaemic. W. WAGNER ("Volkmann's Klinische Vortrage," 1886, and " Vierteljahr- schrift f. Gerichtl. Medizin," 1888) quotes two cases of parietal injuries followed by melancholia. L. LOWENFELD (" Archiv f. Psychiatrie," 1898) : J. L., age thirty, male, single, was hit by a stone on the right parietal bone when thirteen years of age. Since then the injured part was painful and patient became low-spirited and subject to paroxysms of fear. LUDWIG SCHLAGER (" Zeitschrift der GeseUschaft der Aerzte zu Wien," 1857) : Two cases, both with falls on the parietal bone, followed by headache, am- blyopia, depression of spirits, feeling of anxiety, and taedium vitse. PAUL SCHCJLLER (" Psychosen nach Kopfverletzungen," Leipsic, 1882) : A. Sch., a servant, age twenty-six and a half years, fell on her head into the room below, through a floor which had given way. She injured her parietal bone, was unconscious, and had to keep in bed for five weeks. Low spirits, paroxysms of fear and abnormal sensibility were her symptoms thereafter. The SAME AUTHOR {ibidem) : H. S., miner, twenty-nine years of age, had both parietal bones injured in a fight, leaving scars, and on one side an indentation five millimetres deep. He became melancholic, wept readily and a good deal, and deemed himself badly used. DEROUBAIX ("Belgique Medicale," 1906, and " L'Encephale," 1907). Man, 32 years of age, received a blow with a hammer on the parietal bone, after which he developed stuporous melancholia and had to be put in an asylum. HERMANN DEMME( " Militar-Chirurgische Studien," Wurzburg, 1864) : A sergeant-major received a wound in the parietal region. He became a melancholiac of a very bad type. AZAM (" Archives Generales de Medecine," 1881) : Patient, age thirty-three, suffered a contusion of the parietal bone, after which he grew emotional, wept without cause, and became very timid. LUDWIG BRUNS (" Neurologisches Centralblatt," 1889) : A non-commissioned officer received in a quarrel with a soldier several blows with a sword on the left parietal region. He suffered since then from severe headache, giddiness, insomnia, and attacks of utmost anxiety without cause. These symp- toms increased and developed into genuine melanchoha. He attempted suicide by hanging, but was cut down in time. He was brought to the asylum. G. HUGUENIN (" Krankheiten des Nervensystems," Stuttgart, 1880) : A railway-guard, age forty-two, injured his right parietal bone in a train collision. The symptoms were giddiness, defects of memory and paroxysms of anxiety, in which he wept and cried for hours. He attempted suicide on several occasions. He died eighteen months later. S. V. CLEVENGER ("Alienist and Neurologist," St. Louis, 1888) : L., age forty-eight, mechanic, vigorous, cheerful, and industrious, was struck by a flying stone in the left parietal region, and within a year became melancholic. He lost all interest in his former amusements, became helpless and sleepless, and presented the appearance of advanced age. G. ALDER BLUMER (" American Journal of Insanity," 1892) : M. D., age 38, was struck on the right parietal bone, where there remained a slight depression. Suicidal tendencies ever since. Operation was decided upon, but curiously not over the scar, but over the motor area. No wonder it did not improve the patient's condition ! ERNEST TREDINNICK ("British Medical Journal," 1900) : Case of fracture of parietal bone, followed by depression and attempts at suicide. R. THOMSEN (" Charite Annalen," vol. xiii.) : Pieper, watchman, forty-three years of age, previously healthy, fell from a cart on his head and received a wound on the left parietal bone, which left an adherent scar twenty centimetres long. He went on his way, but on reaching home he sufiered from nervous symptoms which caused him to remain in bed for eight weeks. He then tried to resume work, but had to give it up from a feeling of fear and 136 THE MENTAL FUNCTIONS OF THE BRAIN anxiety, palpitation of the heart, and giddiness. There was pain at the seat of the scar. His depression increased considerably and he heard voices, with the left ear only, assailing his character, but was unable to distinguish them as unreal and as due to his illness. He saw faces, too, which inspired him with terror. Sent to the asylum a year after the injury, he was noticed to be quietly behaved, to have an expression of sadness, and there was concentric limitation of the field of vision, with tremor of the hand. He was very anxious, especially at night, and his sleep was disturbed by dreams which increased his terror. The excision of the scar was decided upon, but consent to the operation could not be obtained. The SAME AUTHOR (" Archiv f. Psychiatric," 1884) : W. Schafer, age forty-nine, healthy until two years ago, when he was hit on the head \vith a hammer, rendering him unconscious. On the posterior half of the right parietal bone there was a scar, four centimetres long, with a marked bony de- pression, sensitive to pressure. The wound healed in about six weeks. Patient suffered since from anxiety, giddiness, terror at the slightest noise. If addressed suddenly he gave a sudden start and was unable to speak a word. He was a strong muscular man. His facial expression betrayed anxiety, and his eyes stared. Continuous melancholic depression. Limitation of visual field. The SAME AUTHOR {ibidem) : K. Poehl, age forty-nine, was hit by a locomotive severely on the head, but did not lose consciousness. Scar seven centimetres long, with depression of bone. Admitted to hospital, patient complained of continuous mental depression and suicidal thoughts. Very nervous and easily terrified. Constant feehng of anxiety, which increased in paroxysms. Other Examples of Injury to Parietal Region with Melancholia. J. V. MASCHKA, Gerichtl.-mediz. Urteile, Leipzic, 1873. The SAME, Prager Medizinische Wochenschrift, 1879. LANDERER and LUTZ, Christophsbad Asylum Report, 1878. E. SOMMER, Zur Casuistik der Gehirnverletzungen, 1874. T. S. CLOUSTON, Journal of Mental Science, 1872. Two cases. W. J. MICKLE, ibidem, 1883. STOLPER, Vierteljahrschrift f. gerichtl. Medizin, 1897. E. MENDEL, Progressive Paralyse, 1880. T. C. ENGLISH, Lancet, 1904. Two cases. C. W. BURR, Journal of Nervous and Mental Disease, 1898. MARCHAND, Nouvelle Iconographie de la SalpHriere, 1910. PARIETAL BRAIN TUMOURS AND MELANCHOLIA Examples of Tumours of Parietal Lobe, especially in Angular and supra-marginal Gyri, with Depression, Morbid Fear, and Melancholy. Sir WILLIAM BROADBENT (" Lancet," 1874) : Clara C, age thirty -six, a widow, earning her bread as a needlewoman, well nourished, but rather pale and having a sad expression. She was particulariy inteUigent, but greatly distressed, highly nervous, apprehensive, low-spirited, and often gave way and wept. The emotional depression continued till her death, when two small gummata were found under the parietal eminence, depressing the right Supra-marginal lobule. M. BERNHARDT (" Allg. Zeitschrift f. Psychiatric." 1883) : The patient wa^ a woman, age sixty-three, who for years had made suicidal attempts. She had delusions of having animals in her body and lead in her head, of having no abdomen. The left side of her body she thought was drying up, because she cut her left wrist in one of her suicidal attempts. Post mortem, the greater part of the left parietal lobe was found depressed for about two centimetres THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 137 below its level. The depression was caused by a cyst, filled with serum, beneath the dura and adherent to it. TH. SARLAN (" Allg. Zeitschrift f. Psychiatrie," 1886) : Patient, age thirty-one, father of five children, complained of a sensation of pressure in the parietal region, of sleeplessness, restlessness, and fear ; he easily wept, was afraid of becoming mentally deranged, and had the delusion of suffering from lues, for which he subjected himself on his own account to an inunction cure. His anxiety and fear continued to increase in intensity, and one day he made an attempt at suicide. Patient wept a good deal, searched his whole life for possible causes of his misery, and had to be admitted to the asylum, now suffering for five years, for melancholia agitans. The post-mortem examination revealed a sarco- matous tumour of the parietal lobe. L. MANOUVRIER (" Bulletins de la Societe d 'Anthropologic de Paris," 1885) : The brain of a woman was shown, having a depression, size of a walnut, in the parietal lobe, caused by a fibrous tumour implanted in the bone. The patient, age fifty-one, was an inmate of Orleans Asylum, suffering from melancholia and tendency to suicide. Intellectually she was normal. Sir JAMES CRICHTON BROWNE (" British Medical Journal," 1873) : M. B., age sixty-six, admitted into West Riding Asylum. Family and personal history good. After a transient stroke his mental condition changed completely. He was at first hstless, later agitated, and greatly and unceasingly disturbed as to the safety of his soul Moved by his fears on this account, he would wander about the house during the night, wringing his hands, and would talk about his desire to put an end to his earthly misery. On admission to the asylum he was depressed in spirits, and felt, he said, as if he were being perpetually upbraided by his conscience for having neglected to seek salvation. His memory was found vigorous, his face expressed pain ; he was restless, sighing and weeping, and, again, he was quiet and stolid, taking little or no interest in what was going on around him. All his muscles were tremulous. His melancholia increased. When spoken to, he would, in attempting to reply, dribble into an incontinent emotional overflow of tears. He gradually became paralysed on the right side. He died two months after admission. Post mortem, a cancerous tumour was found involving the whole of the convolutions of the left parietal lobe. L. PIERCE CLARK (" Journal of Nervous and Mental Disease," 1895) : J. B., age thirty-four, married, family history good. His illness began seven months prior to admission with intense depression from being out of employment. He attempted suicide with a razor. When questioned he replied in monosyllables. His articulation was slow and hesitating, and at times he broke down entirely, becoming emotional and unable to answer questions. Muscular tremor in tongue, facial muscles and hands. Kneejerks increased equally on both sides. Depression increased. He failed rapidly in health, and died in a seizure eight months after admission. The autopsy revealed four sarcomata, all over the right parietal region, none bulging beyond the cranial surface. Sir WILLIAM BROADBENT ("Lancet." 1874) : Woman, age thirty-six, suffering from usual signs of brain tumour and mani- festing melancholic depression. A tumour was found post mortem in the right supramarginal convolution. ANDERSON (" British Medical Journal," 1889) : Man, age forty-one, suffering from great mental depression and anxiety. The autopsy revealed a cyst in the gyrus angularis. C. V. MONAKOW (" Archiv f. Psychiatrie," 1881) : R., a well-to-do farmer's wife, age fifty-three, had no illness until her fortieth year, when she became melancholic, with intense depression and self -accusations. Six years in the asylum. Seven years later relapse with morbid fears and suicidal tendency. Re-admitted. Her anxiety much worse, hardly any sound sleep, wept and wailed for days together, accused herself of impiety, and deemed this the cause of her illness. Intellect unclouded, no hallucinations. She died after five years. The autopsy revealed two sarcomatous tumours in the left parietal lobe which had grown together and had perforated the bone. They involved the gyri supra-mar- ginzdis and angularis and surrounding brain substance. 138 THE MENTAL FUNCTIONS OF THE BRAIN HERMANN OPPENHEIM (" Charite Annalen," vol. x.) : Man, fifty-seven years of age, suffering from intense depression and anxiety. Post mortem, a cyst, size of an egg, in left parietal lobe. LUDWIG BRUNS (" Jahresberichte f. Neurologie u. Psychiatric," 1898) : Man, fifty-five years of age, suffering from agitated melancholia, was found post mortem to have a tumour of the left parietal lobe. GLYNN (" British Medical Journal," 1878) : Man, age thirty, suffering from agitated melancholia, was found post mortem to have a tumour of dura mater over gyrus angularis and supra-marginalis. PETRINA (" Prager Vierteljahresschrift," 1874) : Man, age sixty-six, suffering from acute melancholia, sighing continuously and walking up and down all night, moaning and wringing his hands in despair. Post mortem, a huge tumour of left parietal lobe. H. D. DAGONET and P. REY, Asile St. Anne (" Annales Medico-Psycho- logiques," 1882), found a tumour weighing over 350 grammes over posterior parietal area of both hemispheres in a patient whose condition was that of melancholia and stupor. Patient, age twenty-three, fell on his head when seventeen years old ; he died a year after admission. Other Examples of Tumours with Morbid Fears, Unreasonable Anxiety, and Symp' tarns of Melancholia, are given by : T. ZACHER, Archiv f. Psychiatrie, 1888. H. OPPENHEIM, ibidem, 1890. MAROT, Bulletins de la Soc. Anatom., 1875. E. MENDEL, Neurologisches Centralblatt, 1882. STEIN, ibidem, 1897. G. ANTON, ibidem, 1900. TOUCHE, ibidem, 1900. T. S. CLOUSTON, Journal of Mental Science, 1879. WM. BOYD, ibidem. 1873. R. VIRCHOW, Onkologie, vol. ii. P. REY, Annales Medico-psychologiques, 1882. P. NICOL, West Riding Lunatic Asylum Medical Reports, 1872. GIANELLI, Policlinico, 1897. Two cases. PAUL SCHUSTER, who {op. cit.), like the author, has examined the history of cases of parietal tumours, states " that neither progressive paralysis, nor paranoia, nor mania, ever occur in such cases ; but that they are mostly accompanied by states of depression." He sees nothing improbable in the locaUsation of melancholia in this region. CHAS. K. MILLS ("Philadelphia Medical Journal," 1901) declared that tumours ol the parietal lobes are accompanied by emotional depression. W. C. SULLIVAN (" Lancet," 191 1), on the other hand, states : " Actual suicide appears to be a very rare occurrence in cerebral tumour ; I have found only one case mentioned in the hterature of the disease (a case reported by Rey, quoted by Bernhardt, ' Beitrage zur Symptomalogie und Diagnostik der Gehimgeschwiilste,' Berlin, 1881) : and in a series of 1,700 post-mortem examina- tions of suicides reported by Piles (' Ann. Med. -Psych.,' 1908) new growths were found in the brain in only three cases." In my opinion, the localisation theory cannot be proved by statistics. Suicide is committed for a great variety of reasons, and I am quite sure, if we take all the reports of inquests held in England in a year, we shall find very few evidences of brain disease, not to speak of tumours. We are dealing with mental depressions amounting to melancholia, and all melancholies have a tendency to suicide. If statistics are admitted at all, the only ones of value would be those of asylums for the insane. One might as well disprove my statement that lesions in certain parts of the brain lead to kleptomania, and of others to homicide, by taking the statistics THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 139 of all criminals, and showing that only an infinitesimal percentage had any brain trouble whatsoever. EXAMPLES OF MELANCHOLIC DEPRESSION IN SOFTENING OF THE PARIETAL LOBES E. KUNDT (" AUg. Zeitschrift f. Psychiatric," 1894) cites several cases, of which the following is an example : H. Michael, age thirty-three, married, always of good humour, changed half a year ago after a sleepless night. He made an attempt to hang himself, but was rescued in time. He afterwards gave utterance to delusions of melancholia. He beheved himself a thief, a bad and a lost man. He was starving because, as he thought, his stomach would not hold food, it being so constructed that it let every- thing fall through. He died of phthisis. Post mortem, it was found that the pia over the parietal lobe was thick, milky, and the brain substance beneath was atrophic. Sir DAVID FERRIER (West Riding Lunatic Asylum Medical Reports, 1874) : A. B., housewife, age forty-four, suffering from melancholia. Nine weeks before admission the illness began with restlessness and refusal of food . She became very low-spirited, and was influenced by the idea that her soul was lost, because she had been wicked to everybody. She attempted suicide on three occasions, twice by strangulation, and the other time by concealing a razor with intent, etc. The patient had had two strokes, one ten years previously, and the other three years before admission. On admission she was extremely dejected and miserable, her mind dwelling incessantly on her supposed sins and misfortunes. She constantly ex- claimed that she had no home, no clothes, and that she would never be able to pay the debts incurred for her food and clothing there. For this reason she refused food. She died six months after admission. The post-mortem examination revealed wasting and softening of the angular gyrus, and both postero-parietal lobules, with the adjacent area. W. GRANT COOPER (" State Hospitals Bulletin," 1897) : Widow, age sixty, suffered from acute melancholia. Post mortem was found C)^tic softening of the left parietal lobe extending to the occipital lobe. J. LOCKHART CLARKE (" British Medical Journal," 1874) : G., a woman, age seventy-six, one day suddenly became extremely excited, sitting up in bed and throwing about her arms and wringing her hands in apparent mental distress and despair. On being questioned, she replied that she wished to die because she had been wicked. On every other subject she was perfectly rational. This state of excitement lasted for about two months, and recommenced six months later. Night and day she would wander about the house throwing about her arms and turning up her eyes as if in despair, and crjring frequently aloud, " Oh dear, what shall I do ? " She was wholly unable, however, to give any definite or intelhgible account of her mental suffering. This state continued for about a month, during which time she frequently refused to take food, declaring that she was unable to swallow ; so that she was reduced to a state of great emaciation. Then she became quiet, but still distressed in mind. After remaining for about a week in this condition, she gradually and quietly sank. Post mortem, the convolutions of the upper part of the parietal lobes were so atrophied that the spaces between them were in some instances three-quarters of an inch in breadth. It was over this space that the membranes were adherent to each other, as well as to the falx and skuU. Other cases of Softening of Parietal Lobes with Melancholia. VOISIN and BURLUREAUX, De la Melancolie. Paris, 1880. Numerous cases. J. LUYS, L'Encephale, 1881. Two cases. JAMES SHAW, Brain, 1882 ; and another, ibidem, 1895. F. LALLEIk'L^ND, Rech. anai.-path. s. I'Encephale, vol. ii. A. ROSENTHAL, Centralblatt f. Nervenheilkunde, 1889. I40 THE MENTAL FUNCTIONS OF THE BRAIN PATRICK NICOL, West Riding Lunatic Asylum Medical Reports, 1872. PERCY SMITH, Journal of Mental Science, 1890. EXAMPLES OF H/EMATOMA OF THE DURA MATER (PACHYMENINGITIS IN- TERNA) IN THE PARIETAL AREA IN FEAR, FRIGHT, and MELANCHOLIA H. AUBANEL (" Annales Medico-Psychologiques," vol. ii.) mentions several cases of sudden shock followed by raptus sanguinis, where post-mortem haemorrhage in the parietal area and false membrane were found. J. B. BOUILLAUD and J. L. B. CRUVEILHIER made similar observations. L. F. CALMEIL (" Traite des Maladies Inflammatoires du Cerveau ") gives numerous cases. AUGUSTE VOISIN and CHARLES BURLUREAUX (" De la MelancoUe," Paris, 1880) also cite numerous examples of localised haemorrhage in the parietal area, but we will quote only one case as a specimen : Gr., a woman, age thirty-four, hitherto without any serious illness, during the days of the siege of Paris and the Commune became impressed with fear. For two months she could express only one phrase, indicative of her anxiety. She lost all interest in her work and domestic affairs. One evening, when she heard shooting, she grew excited, tore her clothes, and attempted suicide by jumping out of the window. After her rescue she refused all nourishment, and, being unmanageable, her husband placed her in the hospital. On admission she seemed terribly emaci- ated. Her face bore the aspect of terror. Her excitement abated and she lapsed into a state bordering on catalepsy, had to be fed with the tube, and uttered only a few words of terror. Post mortem was found a small subarachnoid blood cyst over the left parietal lobe, and the arachnoid in this region was studded with numerous yellow spots, size of pins' heads, which, on microscopical examination, turned out to be dilated capillaries, filled with haematosine granulations, haematine crystals, mostly discoloured, and blood globules. RUDOLPH ARNDT (" Archiv f. Patholog. Anatomic," 1871) : H. B., age twenty-five, watchmaker, mentally always very bright and Uvely, was noticed by his parent about six years before admission to change in mood and become melancholy. Mentally and physically he became very inactive ; nothing interested him any more. He sat still the greater part of the day, rarely uttering a word, betrayed an anxious uneasiness, and was ultimately removed to the asylum. On admission his face was found pallid and expressionless and his emotional state apathetic. He died of phthisis five years later. In this case a pseudo-membrane was found extending over both parietal lobes, and on the left side the convolutions were flattened by fluid accumulated under the false membrane. C. FROHLICH (" Allg. Zeitschrift f. Psychiatrie," 1875) : C. U., age forty-six, wife of a manufacturer, suffered from melancholia. Her fear and anxiety were intense. She refused all food, considered herself a great sinner, wished herself dead, and made an attempt at suicide. On admission she was found to have delusions of having to die a frightful death, fears of being put in a boiler with seething oil, and of being swallowed by serpents. Pretending to get a breath of fresh air at the window, she, in an unobserved moment, committed suicide by hanging. The autopsy revealed haemorrhage under both parietal tuberosities, W. J. MICKLE (" Journal of Mental Science," 1880) : A soldier, age thirty-five, was depressed and apathetic, sat by himself, never spoke unless addressed, sighed, and took no apparent interest in his surroundings. He was suicidal. The expression was one of sadness and misery. The obstinacy of the patient as to the taking of medicine and food was a source of much dif&culty. The post-mortem examination revealed a false membrane (the organised remains of haemorrhage), size of a five-shilling piece, symmetrically placed in both parietal lobes just opposite the parietal eminence, which was eroded. BRIE (" Neurologisches Centralblatt," 1897) : Catherina D., single, age thirty-six. Five years before her admission she showed the first signs of melancholy. As cause was given rejected love. Her condition gradually got worse, she took no interest in anything, remained silent. THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 141 preferably in bed, and when disturbed she was unfriendly. Post mortem was found in each angular gyrus, right and left, a haemorrhagic focus, with softening of the neighbouring parts. H. D. MACPHAIL ("Journal of Mental Science," 1915) : D. S. B., age twenty-five, well nourished and of good physique, suffering from a first attack of acute melancholia. Previous to admission had made two definite attempts at suicide. His mental state was one of intense depression with delusions of unworthiness and marked suicidal tendencies. Post mortem : Pachymeningitis Interna Haemorrhagica. Other Examples of False Membrane and Pachymeningitis Interna Hamovrhagica with Symptoms of Melancholia. PLINY EARLE, American Journal of Insanity, vol. ii. S. G. WEBBER, Boston Medical and Surgical Journal, 1883. D. J. CUNNINGHAM, Journal of Anatomy and Physiology, 1879. F. A. AMELUNG, Bericht Uber das Hofheimer Spital, 1830. F. C. HOYT, Medical Record, New York, 1892. JOFFfe, Vierteljahrschrift f. Psychiatric, 1867. SEIDLITZ, Zeitschrift f. d. Gerichtl. Medizin, 1809. J. WIGGLESWORTH, Journal of Mental Science. 1888. P. REY, Annates Medico-Psychologiques vol., viii. L. MEYER, Archiv f. Psychiatric, 1872. S. POZZI, L'Encephale, 1883. GAIRDNER, ROBERTSON, and COATS, British Medical Journal, 1875. In support of this clinical observation may be quoted the experiment of KRE- MIANSKY, of St. Petersburg, who produced artificially a pachymeningitis haemor- rhagica circumscripta in the parietal region of dogs, and observed their mental changes. The animals exhibited morbid fear, and refused to take any food. CASES OF MELANCHOLIA WITH WORD AND PSYCHICAL BLINDNESS The next cases are such as have shown symptoms not only of difierent degrees of melancholia, but in addition the symptoms attributed to the angular and supra- marginal gyri by Munk and other observers, namely, word-blindness and psychical blindness, i.e., being able to see words and objects, but failing to recognise them. This defect is apparently due to a disruption of the connecting link with the per- ceptive centres ; and not only of the perceptive centres, but of all the stored-up memories ; in consequence of which such patients lose all interest in life. The melancholy need not persist ; there may be only a sudden, strong depressing emotion at the outset, followed by " word " or " psychical " blindness. J. M. CHARCOT (" Progres Medicale," 1883) described the first case : X., a Viennese reerchant, who spoke German, Spanish, and French, and was well acquainted with Latin and Greek, who had a splendid visual memory for words, inherited from his father, a professor of Oriental languages, also a visual memory which enabled him to recall all persons and objects once seen, and a splendid memory for figures ; he could furthermore draw, well remembering every detail of landscape. On the other hand, his auditory memory was defective, and he had no ear for music. About a year and a half before consulting Dr. Charcot, patient had great anxieties about some debts, which he thought he might not be able to pay. He lost his appetite and could not sleep. When, after all, his financial worry proved groundless, his worry and anxiety did not cease, but went on for a whole year, during which he continued apprehensive without any reason, until one day he perceived a great change in himself, which made him think he was going mad. He was already very nervous and irritable. Although he could see everything as before, he had lost the optic memory for forms and colours. This only increased his anxiety. 142 THE MENTAL FUNCTIONS OF THE BRAIN Whenever his business called him to a town which he had been in the habit of visiting, he now felt as though he were in a new town, not recognising the streets, buildings, or monuments. Only after staying some time could he recollect them anew. He could not figure to himself objects mentally. He could not draw from memory any longer. He could not remember the form and features of his wife and children. In addition he had a certain degree of word-bUndness. The examination of his eyes revealed no change. He trained his memory afterwards by his auditory impressions, repeating words aloud. COTARD (" Archives de Neurologic," Paris, 1884) : M. P., age sixty-eight, diabetic, came first to the asylum in 1872, when suffering from melancholia. He was in a continuous state of fear and apprehension, and refused food. He beUeved himself ruined, incapable, and wished to end his life. Sometimes he sat quite motionless. At other times he would walk up and down the room repeating that he was the most unfortunate man in the universe, that he Wcis lost, and that he would never recover. It was extremely difficult to get him to dress himself or to perform the most necessary acts of life. Yet a year later he had so far improved that he was permitted to join his family at home. He returned in 1881, with the like symptoms of anxious melancholia, with similar delusions, only more intensified. He thought himself totally incapable, devoid of energy or in- telUgence, and possessed of all possible miseries. His hypochondriacal ideas increased. He now asserted that he had no blood, that his whole body was rotten, that he was going to die, that he was already dead. For several months he had complained that he could not represent mentally the objects with which he was formerly quite familiar. Thus, he could not remember a single picture of the town in which he had been living for a long time, and every shop and house which he knew formerly and could picture to himself with closed eyes. Even the face of his wife he could not call to mind, and sometimes it seemed to have quite vanished from recollection. The AUTHOR himself has seen two extraordinary cases of mental depression with loss of memory : Both received blows on the parietal region, but without leaving scars. The one in a railway accident, the other, a naval officer, in a submarine explosion. Both had recently married, and exhibited, besides mental depression, loss of visual memory. Both after recovery from unconsciousness failed to recognise their wives, and persisted in denying they were married to them. As one of them put it when consulting me, " This lady claims to be my wife. ... I know nothing about her." The second case led to a separation, as a child was bom five months after the accident, the parentage of which the officer denied, notwithstanding the assurances of the entire family. Case of Parietal Tumour — Melancholia — Psychical Blindness. C. S. FREUND (" Archiv f. Psychiatric," 1889) : Patient, age fifty-seven, suffering from word-blindness and psychical bhndness. The mental state is described as follows : " However the moods of the patient may vary, one expression predominates over all others and is perceptible, whether the features are at rest or in motion. It is the expression of anxiety. The patient looks helpless and in fear. He was very emotional, crying easily without sufficient cause. Even to his own physicians he speaks but little, and that guardedly. Only when completely assured of the friendly feeling which the visitor entertains towards him does his reserve give way, and then talks as freely as his defect will allow him." Post mortem, a sarcoma involving the meduUary portion of both parietal lobes was found. Case of Parietal Atrophy — Melancholia — Psychical Blindness. The SAME AUTHOR {ibidem) : C. K., age sixty-eight, gave constant sighs, groans, and lamentations, without any reason, certainly not from pain. His face and whole demeanour expressed helplessness and perplexity. His surroundings seemed strange to him. He THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 143 seemed psychically blind, and he did not know where he was. He did not under- stand that he was being medically examined, but looked on the physicians as his enemies, against whom he must defend himself. He was in fear to leave his bed, and when he did get out he moved about with the utmost caution. No paresis, however. He sat brooding, a picture of absence of all will-power. After three weeks his weeping, sighing, and moaning still continued. Case of Tactile Amnesia — Psychical Blindness and Melancholia. CHARLES W. BURR {" Journal of Nervous and Mental Disease," 1897) : Patient suffered from inability to recognise objects by the sense of touch, and had mind-bhndness, i.e., inability to recognise objects by the sense of sight. She remained in bed, dull, apathetic, talked little, and showed no interest in anything. Other Examples of Melancholia with Psychical Blindness. G. ANTON, Wiener Klinische Wochenschrift, 1889. Synunetrical lesion. A. CHAUFFARD, Revue de Medecine, 1881. KUCZINSKI, Neurologisches Centralblatt, 1910. CASES OF SYMMETRICAL ATROPHY OF THE PARIETAL BONES IN MELANCHOLIC STATES OF MIND Numerous observers — Larrey, Broca, Virchow, Rokitanski, Maier, Chiari, Fere, George M. Humphry, and others — have been in possession of skulls with sym- metrical depressions on both parietal bones. There is also one in the College of Surgeons' Museum in Lincoln's Inn Fields. The observers have described the "naked eye " and "minute " anatomy of these deformities, but were unable to discover the cause. These parietal depressions commonly exist on the two sides, and are symmetrical in position and more or less alike in size. They are situated at some distance on each side of the sagittal suture, if not on the parietal tuberosity itself. The thinning is sometimes so considerable as to produce a hole or perforation in the centre. These depressions do not present any indication of being the result of disease, such as sjrphilis, as ROKITANSKY has assumed. They are certainly not the result of external influences or accident. Changes in the circulation alone would not cause in the part such a circumscribed sjonmetrical wasting. These depressions are not congenital, as HUMPHRI thought, nor is MAIER correct in attributing the circumscribed thinning of the skull to senile atrophy. The author finds that in those authenticated cases in which a clinical history was obtainable, such history was invariably one of psychical pain and melancholia, and that it is therefore probable that these localised changes in the skull may be due to trophic influences, R. VIRCHOW (" Verhandlungen der Phys. Med. Gesellschaft zu Wiirzburg," 1854) showed the skull of a man whose chief symptoms besides pain and giddiness were intense melancholy, and whose facial expression had been observed to be always one of extreme sadness. On both parietal bones, exactly corresponding to the eminences, the bones were so thin as to be perfectly transparent when held against the light. Virchow described the morbid histology of this affection minutely. RUDOLF BLOCH (" Prager Medizinische Wochenschrift," 1897) : Patient, age eighty-six, had a round depression of four and a half centimetres diameter on each parietal bone. Patient was in a condition of mental depression and bore the indicia of anxiety. She was tremulous, slow of speech, and hesitating in her answers, and wrung her hands despairingly. Her intellect was quite normal. History of suicide in her family. Two weeks before admission she had made two attempts to kill herself, trying to knock her skull in with a hammer, showing sttU an open wound, and a day later she used a knife, but was stopped just in time. Later on it was ascertained that she had been in the same institution some thirty 144 'rHE MENTAL FUNCTIONS OF THE BRAIN years before, and on looking up the case-book it was discovered that she was then treated for symptoms of fear and depression and for boring pains in her head, and that then shortly before her admission she had made four attempts at suicide — two by drowning, one with a pocket-knife, and one with a razor. Post mortem, the examination of her skull showed that in the thinned cranial parts the lamina externa and diploe were completely absent. The lamina vitrea appeared un- changed, and at the borders of the depression the diploe was heaped up and there was hyperostosis of the lamina externa. The SAME AUTHOR {ibidem) gives a second example. LUDWIG MEYER (" Archiv f. Psychiatrie," 1872) : C. Th., age forty-four, single, became melanchohc in his forty-first year, it is said through disappointment in love. Hypochondriacal delusions of changes in his own body, effected by women. Repeated paroxysms of fear, with a tendency to self- mutilation — one attempt, cutting his veins in neck and at wrist, nearly caused his death. On admission he wailed and moaned over his supposed misery. Had attacks of acute fear. The autopsy revealed atrophy of both parietal eminences. ROSSBACH (" Deutsches Archiv f. Klinische Medizin," 1890) : Patient, age forty-nine, had suffered from melancholia for twenty-five years, had symmetrical atrophy of both parietal bones. The skull and two others, of identical cases, were shown at the German Psychiatric Congress in 1889. Other Cases of Symmetrical Atrophy of both Parietal Bones with Symptoms of Melancholia. H. SCHULE, Sektionsergebnisse bei Geisteskranken, 1874. W. B. PRITCHARD, Journal of Nervous and Mental Disease, 1890. H. VOPPEL, Allg. Zeitschrift f. Psychiatrie, vol. xiv. W. FRANKEL, ibidem, 1877. KIRCHHOFF, ibidem, 1883. CASES OF ABNORMAL EXPANSION OF PARIETAL BONES IN MELANCHOLIA The author has seen several such cases, but they are rarely mentioned in medical literature. J. E. D. ESQUIROL ("Mental Diseases ") mentioned some. F. A. H. VOPPEL ("Allg. Zeitschrift f. Psychiatrie," vol. xiv.) recorded four such cases. M. RIVET ("Bulletins de la Societe Anatomiquede Paris," 1887) mentioned the case of a melancholic with suicidal tendency whose parietal bones were of extra- ordinary expansion and thickness, and whose brain was flattened in this region. A. CAMPBELL CLARK (" Journal of Mental Science," 1879) : John R., age thirty-eight, showed post mortem a uniform increase of the natural convexity of the left parietal bone, and the left parietal eminence jutted out abruptly about one inch below the sagittal suture, and therefrom downwards showed a well- marked convexity. The pia mater adherent to the marginal convolutions on both sides. Clark says : " The emotion of fear, as already observed, was very strongly marked. This emotion, believed to be the lowest of its class, was, when excited in him, quite beyond the control of his will, and no amount of experience could rid him of it, or lessen its intensity. Thunder was a great terror to him, and its first peal was the signal for covering himself over with the bedclothes. When placed in an armchair, though protected all around, he was in a state of deplorable misery, until he was brought back to bed, so great was his fear of falling." Altogether, " the most exaggerated faculty in him was the emotion of fear." CONCLUSION Sufficient evidence has been given, I hope, to prove that the supra-marginal and angular gyri are in some way connected with the emotion of fear and the mental THE EMOTION OF FEAR AND ITS CEREBRAL ORIGIN 145 disorder known as melancholia. Lesions of the frontal lobes may cause similar symptoms, but only when the emotion of fear and the complex characteristics which underUe melancholia have been previously active, and through the frontal lesion complete control over these mental powers is lost. I admit no other exception. Certainly, simple melancholia does not occur in lesions of the temporal lobe ; but only when complicated with delusions of suspicion. (See Chapter XXXII.) According to CHATELIN and de M ARTEL {op. cii.), there are in a certain number of cases no symptoms in lesions of the parietal lobes, and in the remainder only dis- orders of sensibility, and aphasia and apraxia. Although I pubhshed the greater part of my evidence in my works on " The Mental Functions of the Brain " (1901) and " Mental Symptoms of Brain Disease " (1910), and originally in the " Journal of Mental Science" (1900), and have been quoted in several text-books, as by BIANCHI and by SCHUSTER, the authors appear not to be acquainted with it, or think it insufficient to deserve notice. But, if Chatelin and de Martel have observed no symptoms in lesions of the parietal lobes, then the results of experimental physiology are also discredited, and we are back again where we were fifty years ago, and the laborious and extensive experiments on animals have been in vain. Dr. RICHARD EAGER (" Journal of Mental Science," April 1920) in his Report (see prev. chap., p. 121) claims to have had only three cases of parietal injury. The first case mentioned is that of a man who had been wounded by a shell splinter " just above the right ear," and therefore not in the parietal, but in the temporal region ; and the mental change exliibited corresponded to those described in lesions of that area (see next chapter) ; " Formerly a steady quiet man, he was now noted as show- ing a marked insubordination . . . laughing in his officers' faces," having "lost all sense of discipline." " Formerly a staunch teetotaller, he now took to drink." The second case was that of a boy, age nineteen, wounded by a bullet over the upper part of the parietal region, which, in my opinion, corresponds to the posterior end of the frontal lobes, and so did the sjnnptoms exhibited. He had a record of good conduct all his life, and now became " a notorious liar and full of deceit in every way." The third case was that of a man below average intelligence, and should not have been included. One case was returned as " psychasthenia, " but seems to have been really one of "morbid fears." This patient suffered from " syphilophobia, " which developed some months after a bullet wound in the posterior part of the left parietal region. Vol. 11. J CHAPTER XXXI THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN Irascibility is a primitive emotion and has for its object the overcoming of obstacles and foes for our own preservation. Anger increases tlie bodily energy, enabling us to remove things that threaten us, and is thus a reflex mechanism of immense value in the struggle for existence. It is an innate mechanism manifested long before the living creature has had any experience. The disposition to it varies in degree in different individuals. In its healthy state it gives executive power ; in its un- healthy state it is manifested iii chronic bad temper and quarrelsomeness. Its extreme can be observed in " irascible insanity " (acute mania), in which there are ungovernable spontaneous motor impulses and violent anger, generally without loss of knowledge of the surroundings. The person may be so furious as to exhaust himself in shouts, threats, and actions ; or the passion may be less vehement, but in all cases it is " anger." When it is fully established, it is an ungovernable intense excitement, a wild paroxysm with a blind desire of destruction, and must not be confounded with the harmless restlessness of the anxious melancholiac. It will be seen from several hundred examples cited in the following pages that when the temporal lobe, more particularly at its base, is stimulated, states of excite- ment (irascibility) are produced. WTien FERRIER excited this region in cats and jackals, " the application of the electrodes in this region caused the animal to make a sudden spring or bound forward, pricking up both ears, as if preparing to fight, and opening of the mouth, associated with vocalisation and other signs of emotional expression, such as spitting and lashing the tail as if in rage." Excitation of this area in man produces irascibility, from the simple form of anger to furious and even homicidal mania. When the tendency to irascibility is innate, there need be no temporal lesion, but injury or disease of the frontal lobes may, owing to the loss of control, give it exaggerated activity. But I have not come across a single case of irascibility with disease limited to the parietal lobe, except that form of melancholia called "agitated " melancholia, just as I have found not a single case of melancholia in which the disease was limited to the temporal lobes. With the agitation caused by delusions of persecution I shall deal later. The evidence for the temporal lobe being in some way the centre of a reflex mechan- ism for the protection of self by states of excitement which give additional energy to the entire body is overwhelming. The temporal lobes are separated only by a very thin partition of bone from the internal ear and can therefore be irritated by extension of ear disease, leading to various degrees of excitement and mania, which disappear with the treatment of the ear trouble. Affections of hearing differ in this respect from affections of sight, which, when due to central lesion, lead to mental depression, paroxysms of fear, and melancholia, with attempts at self-destruction. I shall also show that while discharge from the ear continues the patient may be quiet, but on cessation of the escape of pus a violent attack of mania may ensue. These facts are not all proved yet, but observations in confirmation of some of the statements have been made by THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 147 a number of authors — Griesinger, Jacobi, Komer, Huguenin, Morel, Paul Robin, Bennett, and MacEwen, besides those whose cases will be quoted. Further, I pointed out nearly twenty years ago, in the " Mental Functions of the Brain," that lesions of the temporal lobe may lead to epilepsy as well as violent mania. No other part is so vulnerable in this respect as the temporal lobe. Re- cently several observers have admitted that " tumour " situated in this region may give rise to convulsive fits, and THEODORE MEYNERT (1833-1892) long ago found that in epilepsy the greatest atrophy and loss of weight is in the temporal lobes ; but that is all that has been acknowledged so far. For a time it has been thought that excitation of the motor area gave rise to epilepsy, but it does so only in what is called Jacksonian epilepsy, not in ordinary epilepsy. ALDER BLUMER trepanned over the motor regions in ten epileptics, but neither the number nor the severity of the fits improved ; whereas I shall quote several cases in which the fits disappeared on treating the lesion of the temporal lobes ; and not only the fits, but the mania as well. Sometimes the temporal lobes are sound, but distension of the lateral ventricles causes pressure on them. Sometimes also mania and epilepsy are caused by fractures of the base of the skull through extravasation of blood into the brain tissue and tearing of the structure of this region. Sometimes an epileptic fit may be replaced by a paroxysm of acute mania, which fact shows the intimate relation between the two, the convulsive and the maniacal attack. Both are paroxysmal and explosive, violent and sudden. The change of disposition in the epileptic is remarkably characteristic. From this change alone an experienced observer will frequently be led to infer the presence of epilepsy. There are present extreme irritability, a combative tendency, undue suspicion, violent outbreaks of temper, and frequently strong homicidal tendencies. Post- epileptic violence is impulsive ; it precludes the existence of animosity or pre- meditation ; there is generally an entire absence of motive or cause of quarrel. That this mental state is due to the disease and not to any predisposition to violence is shown by the fact that so many epileptics, in the intervals between their fits, find genuine consolation in rehgious devotion, that they are ever hopeful, and fully appreciative when sympathy is shown them in their suffering. J. A. ORMEROD (" Brain," 1884) gives one hundred cases of epilepsy, among which forty-six suffered from ear disease. It is a well-known fact that there are some insane patients whose mental dis- turbance dates from the time of an apoplectic stroke. Considering the proximity of the temporo-sphenoidal lobe to the corpus striatum, in which most of the haemor- rhages take place, it is not surprising that such patients, even when not insane, become excited, irascible, and quarrelsome. They are rarely seen in asylums, for they hardly ever become so excited as to be dangerous, and, secondly, because the accompanying hemiplegia prevents them from becoming violent. Neurologists, on the other hand, study more the derangements of the motor and sensory functions, and would take but little, if any, notice of the mental changes. J. LUYS (" L'Encephale," 1881) found that in hemiplegics, whose temper is easily irritated, the temporal lobe was involved. ALBERT ROSENTHAL has described cases of patients with hemiplegia who mani- fested agitation and bad temper, and in whom the temporal convolutions showed lesions post mortem. (" Centralblatt f. Nervenheilkunde," 1884 and 1889.) If further proof were needed of the fact that congestion of the temporal lobes leads to irascibility, violent and destructive tendencies, we have it in the frequency of hcsmatomata auris, which seem to be d. to a sanguinous perichondrial effusion of the auricle, and appear to withdraw the l>iood from the adjacent brain substance ; 148 THE MENTAL FUNCTIONS OF THE BRAIN hence, on the appearance of the haematoma, it is not uncommon that the mania ceases. If this theory be correct, one would expect also in chronic mania an increase in the size of the temporal lobes, and I shall publish some cases in confirmation thereof. Neurologists and alienists should also be interested in the fact that in the con- gestion of the temporal lobes caused by various lesions, patients otherwise aphasic can still utter " oaths " when they can articulate nothing else. Sir W. T. GAIRDNER (1824-1907) and HUGHLINGS JACKSON (1834-1911) called attention to this peculiar affection, and I shall also cite some such cases. Another observation of interest and confirmatory of this localisation is that word-deafness and acute mania can and do sometimes occur together, while word- bhndness is never found associated with it, but always with melanchoUa. In the " Gazette Medicale de Bordeaux," July i6th, 1911, is an article entitled "La Jargonaphasie Logorrheique," in which volubility without word-deafness in lesions of Wernicke's area is described. When the lesion bordered on the parietal the patients were sad, otherwise all the cases were gay and irascible. Altogether there will be placed in this chapter at the disposal of the physician and physiologist an overwhelming mass of clinical material and pathological observa- tions which cannot be passed over lightly. RECOVERY AFTER SURGICAL OPERATION HERBERT A. POWELL (" The Surgical Aspect of Traumatic Insanity," 1893) quotes the following case from the " Pacific Medical and Surgical Journal," 1884 : A Swede, age thirty-five, in the Arizona Penitentiary for manslaughter, was found by the medical officer in a state of wild mania. On examining him, he found a depression covered by a cicatrix above and rather behind the ear. No history of the cause of this depression was forthcoming from the man. He grew much worse, and, as a last resource, was trephined, and depressed bone, two and one-eighth inches by seven-eighths of an inch in area, was removed. Shortly after his recovery from the anaesthetic, he said in English, " I am hungry — I want something to eat." It was not before known that he could speak English. He talked quite rationally with his attendants and seemed cheerful. Twelve days after the operation he gave his own history. DANIEL MOLLIERE ("Lyon Medicale," 1881) : Patient, age forty-one, was admitted on account of maniacal furor. His roaring terrified his companions. On examining the head, a slight wound was found in the left temporal region, just above the external auditory meatus. On probing it, a fracture of bone beneath was detected. Patient was trepanned, and pus was found beneath the dura mater. Two days later he recognised his friends, made sensible inquiries, and after a month left the hospital a normal man. He reported liimself three months later perfectly well. E. HOFFMANN (" Deutsche Medizinische Wochenschrift," 1881) : A man, age fifty, was struck by a heavy board falling from a great height on to his head. He lost consciousness and became delirious. Afterwards he had attacks of furious mania, in which he caused tremendous destruction in his household, so that he had to be removed to the asylum. He complained of pain in the head. He had no convulsions or any motor or sensory symptoms. On the right side of the head, a little above and behind the external opening of the ear, was found a small but tender depression of bone, about the size of a shilling, which was resected, when on incision of the dura four spoonfuls of cerebro-spinal fluid streamed out. The pia was turbid and oedematous, and more fluid escaped therefrom. The wound healed well. No further attacks of destructive mania — ^in fact, no psychical sjrmptoms of any kind. Discharged cured, and reported himself six months after- wards as perfectly well. E. V. BERGMANN (" Volkmann's Hefte," No. 190) : A. H., age thirty-nine, fell from a scafiolding about six yards high. The only THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 149 marks of injury were on the right side of the head just above the ear. Patient was so excitable and restless that he had to be restrained. He recovered after surgical treatment. JAMES HOWDEN (" Journal of Mental Science," 1875) : J. S., age fifty-one, received an injury to his head, and became insane. He was restless, raging, and dangerous to others, and so remained until the forming of a large abscess in the left temporal fossa, which was opened, when he became sane again. ERNST SOMMER (" Zur Casuistik der Gehimverletzungen," 1874) : A coachman, age twenty-five, fell from a ladder and fractured his right temporal bone ; haemorrhage from right ear. The temporal arch was much swollen. Patient became acutely maniacal and had to be isolated. An abscess formed over the left ear. After surgical intervention and removal of necrosed piece of bone he re- covered. J. A. E. ESTLANDER (" Finiska Lak Handlingar," 1897) : Boy, age thirteen, with violent mania after injury to temporal bone. Operation. Recovery. P. GUDER ("Die Geistesstorungen nach Kopfverletzungen," 1886) : Case 7, periodical attacks of violent mania. Two long scars across temporal bone. Operation. Recoverv. SERGER (" Allg. Zeitschrift f. Psychiatrie," 191 1) : Mania after fracture of temporal bone. Operation. Recovery. SAVORY (" British Medical Journal," 1869) : J. B., age twenty- two, a brakesman on the underground railway, was found lying across the line by the guard of another train. When admitted he was quite unconscious. There was a slight wound behind the left ear. There was grinding of the teeth. The right temple was swollen. He became so violent that he had to be strapped down. He was noisy and used obscene language. He recovered after surgical treatment and was discharged six weeks after the accident. He had no recollection of it. A Boy with Uncontrollable Propensities Improved by Craniectomy. A. SPANBOCK (" Neurologisches Centralblatt, " 1895) : Lipe Spielmann, a boy of fourteen, had been physically and mentally slow in development. He teethed only at the end of the second year, learned to walk only when three, and began to speak when four years old. He was sent to school in his ninth year, but made absolutely no progress ; took three days to learn one letter and then forgot it. All efforts to teach him anything were fruitless ; he did not learn to read, write, or to count. Morally, also, he remained undeveloped. He thrashed his fellow-pupils when he could. The older he grew the more dangerous he became to the family. He had to be constantly watched to keep him from destroying things, or beating or throwing stones at someone. His deeds brought him frequently before the police courts, to the great annoyance of his family. The boy getting worse, a medical consultation was sought. The boy was well built. On admission it was observed that his frame, with the exception of the skull, was regular. The latter showed signs of degeneration ; low forehead, big ears, ab- normally high palate, teeth widely apart. He also had " tic convulsif " of the right M. orbicularis palpebrarum. The patient could not remain still in any one place, he shouted abusive words at everybody, did not reply to questions, or repeated in a senseless manner the questions put, or, if he did reply, it was with foul words. He could not fix his mind for one second, there was a constant flight of thoughts. He told falsehoods and had a tendency to steal. He had no sense of decency or feeling for others. Craniectomy was proposed and carried out. An incision was made in the sagittal line, another vertically down to each ear. The latter incision revealed the site of a former injury. The tissues above the right ear were adherent to the temporal bone. After several trepannings had been made the bone was cut away, when on the right side the cortex was found oedematous, and looked as if covered with gelatine. There was no improvement, mentally or morally, im- mediately after the operation ; on the contrary, the strait-jacket had once to be 150 THE MENTAL FUNCTIONS OF THE BRAIN used. Yet in the course of a year there was a gradual change. He now behaved properly, did not disturb anybody, showed no inclination for destruction, but on the contrary tried to make himself useful to his family. He spoke politely, and showed gratitude. " He was even able to blush." Intellectually, improvement could only take place with education. Homicidal Tendencies Apparently Relieved by Surgical Operation. G. BURCKHARDT (" Zeitschrift f. Psychiatrie," 1891) : B. R., widow, age thirty-seven, had hallucinations of hearing with impulses to kill her sister and child. A portion of the brain weighing three grammes was removed from the posterior part of the first and the middle of the second temporo- sphenoidal convolutions on the left side. The substance of the brain was found unusually soft. Sensory aphasia after the operation, but fewer hallucinations. Her quarrelsome tendencies and impulses to kill seemed to have disappeared, and she was delighted to be with her child again. She was discharged. She was unexpectedly found drowned one day, and it was possible she committed suicide, though she was then quite free from mental disturbance. Operative Cure of Homicidal Mania and Epilepsy of Twenty-five years' Duration. BOUBILA and PANTALONI, of Marseilles (" Gazette des H6pitaux," 1892) : Woman, thirty-one years of age, received at the public insane asylum at Bouches- du-Rhone for imbecility with uncontrollable impulses of violence. The only noticeable incident in her history was that she had a fall at the age of six, which still left a scar with depression in the bone in the left temporal region. Before that accident she was a normal child. After it she became queer, insubordinate, irritable, and quarrelsome, and could not be kept in any school. At the asylum she was the terror of her companions, and even attacked the physicians. Epileptic fits developed. She was trephined, and a portion of bone which pressed on the brain removed. A month after the operation it was noticed that she had changed in her conduct ; there was no more disgraceful language, insolent behaviour, acts of violence, but modesty, deference, and grateful emotions. She was anxious to work. Her fits ceased. She was released a year after the operation. Cases of Homicidal Mania, with Recovery after being Trephined. LAMPHEAR ("University Medical Magazine," 1893). COHUIRSCOand MILHAERCO ("Spitalerd," Aug. 1907) : Patient struck in right temporal region by a horse's hoof developed acute mania. Recovery after trepanation. Case of Violent Delirium, with Recovery after Surgical Operation. ERNEST LAPLACE ("Medical and Surgical Reporter," 1896) : Mrs. D., age fifty-four, was struck by her husband with his fist on the left side of her head. She became insane with violent mania a short time afterwards. She was taken to the asylum, where she was in a violent delirium, " causing so much disturbance as to be handcuffed and isolated." She was trephined in the left temporal region, where the bone was found very much thickened and the dura congested. " Three weeks after the operation she returned to her home absolutely well, and is so still, at this moment, six months after the operation." Example of Epilepsy and Homicidal Mania of Seven Years' Duration cured by Operation. W. B. FLETCHER ("American Journal of Insanity," 1887) : C. E., age thirty-seven, was struck on the head when thirteen years old with a small wagon wheel ; had epilepsy when twenty years old, and married at twenty- two. In a fit of frenzy he killed his two-year-old child by catching hold of its feet THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 151 and beating its brains out. Admitted to the hospital at the age of thirty, he continued violent and homicidal. Trephined. The convulsive fits and mania ceased. Six months after discharge still well. Examples of Bullet Wounds, causing Mama ; Operation /Recovery. AZAM ("Archives Generales de Medecine," 1881) : X., age thirty-eight, was shot in 1870, the ball penetrating his skull at the upper end of the fissure of Rolando, and coming out about nine centimetres above the external auditory meatus. A peaceful, agreeable man previous to the injury, he had changed to a bad-tempered fellow who became violent without provocation. He was trepanned and the ball extracted . After the operation the patient regained Ills forniGr ch3,r3,ctGr H. F. W. WENDT (" Allg. Zeitschrift f. Psychiatric," 1875) : A soldier, age twenty-five, received a shot along the whole of the temporal region at the battle of Hallue. A year and a half later he had hallucinations of hearing and became violently maniacal, the attack setting in with a piercing pain in the left temple, and lasting five to eight days. Patient when well was a quiet and modest man. In his attacks he was noisy, quarrelsome, abusive, and violent. Two pieces of lead were extracted. Six months later he reported himself well and free from 3.tt3.cks Sir THOMAS SMITH (" Lancet," 1879) : Similar case of bullet wound in temporal lobe, with recovery. MANIA SUBSEQUENT TO EAR DISEASE SUCCESSFULLY TREATED Case of my own : Young girl, age fifteen, had regular fits of maniacal excitement, in which she destroyed whatever she could lay her hands on, threw the furniture about, tore her younger sister's hair out, and tried to stab her eyes when unobserved. When free from attacks she was a modest, quiet girl. She suffered from middle ear trouble, for which she was surgically treated. On evacuation of the pus, she became perfectly well. LUDWIG MEYER (" Deutsche Klinik," vol. vii.) : T., age forty-five, changed in character about two years previous to his ad- mission. Always of cheerful temper, amiable towards his family, peace-loving and sociable, he grew irascible, kept in ill-humour for days together, and was often violent and dangerous to those about him, and the strait-jacket had to be applied to him frequently. A few days after admission a putrid discharge from the ear was noticed, and simultaneously his mania ceased. Two months later the discharge stopped, and then his fury recommenced, so that he had to be isolated. In three days' time the discharge reappeared, and the mental excitement diminished and ultimately gave way. This repeated itself so often that the attendants began to regard the otorrhoea as a barometer of the mental state of the patient. One day, however, the discharge ceased without any signs of mental excitement, but it was observed that the pus had made its way to the mastoid cells, where a tumour could now be seen. On incision and subsequent proper treatment, patient was cured of his ear trouble and with it of his mental derangement. J. KOPPE (" Archiv f. Ohrenheilkunde," 1875) : Hoffmann, bricklayer, sustained in his forty-ninth year several injuries to his left ear. Gradually he became irascible, quarrelsome, and dangerous to his wife and children, with whom he had lived on happy terms previously. On treatment of the ear disease he recovered his sanity. B. BALL (" L'Encephale," 1881) : Patient, age twenty-two, received a blow on left ear when thirteen years of age, which was followed by perforation of the tympanic membrane with putrid discharge, also noises in the ear. He sought treatment on account of his uncontrollable paroxysms of anger. Later he also heard voices of an insulting character. The otitis media was treated, and with it the mental symptoms gradually disappeared. 152 THE MENTAL FUNCTIONS OF THE BRAIN Ear Disease in Child leading to Violence and Destructive Tendency. Treatment; Recovery. E. BOUCHUT (" Gazette des Hopitaux," 1877) : A child, six years old, alarmed its parents considerably by its frequent attacks of delirium, presenting all the characters of madness. Not recognising its parents, it would endeavour to strike and beat them ; it would break up all the furniture in the place and run its head against the walls, thinking them living beings, all the time shouting noisily. The attack would last several hours, and occurred at night as well as during the day. The attack being over, the child would grow calm, recognised those around him, and be none the worse but for a slight headache. There was no sign of epilepsy or meningitis, or any other nervous symptom other than those mentioned. On questioning the parents, it was ascertained that the child had had a discharge from the right ear. On examination, the parts around the ear, particularly along the sensory nerves, were very tender. After treatment the attacks ceased and did not again recur. Another Simitar Case. W. S. BRYANT ("Journal of Nervous and Mental Disease," 1906) : A girl, age five, had chronic ear trouble of a purulent nature. Whenever there was retention of pus the child had maniacal attacks, during which she broke every- thing within reach and fought desperately with all the members of the family, including those she was most fond of at other times. Drainage of the pus cured the patient. Case of Irascible Mania with Improvement after Treatment. R. V. KRAFFT-EBING (" Uber die durch Gehimerschutterung u. Kopf verletzung hervorger. psych. Krankheiten," 1868) : J. S., age twenty-five, innkeeper, no hereditary predisposition, previously healthy and of peaceful character, married to an evil-tempered woman, who one day threw a porcelain jug at him which struck him on the left temple. Two deep wounds in front and above the ear were the result, one having cut the temporal artery across. The wounds healed normally, but already after three weeks there was pain radiating from the scars and evoking great irascibility. The patient became violent, attacked those who approached him, complained of sleeplessness, buzzing in the left ear, from which pus oozed. His violence and destructiveness increased, necessitating his admission. There was oedema around the scar, and at the posterior part one could feel a distinct depression of the bone with projecting edges. The part on pressure proved very painful. Tormenting tinnitus aurium. On the ear trouble being attended to, the excitability of the patient diminished, and he was able to be discharged four months after admission. On later inquiry it was found that he still suffered from pain over the area of the depressed bone, was still easily roused to anger and rage, but they passed quickly away. Other Examples of Maniacal Excitement cured by Treatment of Ear Disease. H. SCHULE, Handbuch der Geisteskrankheiten, 1878. Three cases. W. RHYS WILLIAMS, Lancet, 1877. G. C. BABLETT, American Journal of Insanity, 1877. Two cases. J. O. GREEN, Boston Medical and Surgical Journal, 1905. SIR WATSON CHEYNE, British Medical Journal, 1890. FRANCIS SKAE, Edinburgh Medical Journal, vol. xi. VIOLENT MANIA AFTER INJURY TO INFERIOR TEMPORAL CONVOLUTIONS A Medico-Legal Case. R. v. KRAFFT-EBING (" Uber die durch Gehirnerschiitterung und Kopf ver- letzung hervorgerufenen psychischen Krankheiten," 1868) : J. L., healthy up to his twenty-first year, a quiet, peaceful man ; family history THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 153 good ; was attacked one day and struck on the left side of the head above the ear, causing haemorrhage from the ear. He was unconscious for nine days and sub- sequently deaf in left ear. From that time he became avaricious, greedy for money, irascible to an ever-increasing degree, so that he could bear no contradiction and at orxe took to personal violence. Four years after the accident he married, but he ill-treated his wife and children for no or but very trifling cause, and beat them until they bled and were half -dead. Punishment had no effect on him. One day a neighbour teased him and challenged him to shoot if he dared. L. did so and killed him. He immediately gave himself up with the pistol still in his hand. His state of mind was inquired into. He was transferred to an asylum. His irascibility and violence continued there, also his covetousness. He threatened to shoot all the doctors. He sufiered from headache, giddiness, and tinnitus aurium, but there were neither motor disturbances nor hallucinations. The SAME AUTHOR {ibidem) : G. G., age fifty-eight, a farmer, untainted and hitherto healthy, was run over at the age of twenty-three by a cart in such wise that the wheels passed over his head, producing a dent in the bone over the left ear three inches long, one inch broad, and half an inch deep. Patient was unconscious for a long time, recovering, however, completely, there remaining only some deafness in the left ear with an occasional paroxysm of rage. These affections did not, however, interfere with his vocation for twenty-three years. Two years prior to admission, subsequent to some financial losses, his excitability increased, and he had an attack of acute mania, lasting several weeks, which was repeated again and again after lucid intervals of eight weeks. In these intervals he was mentally torpid, and had to keep a good deal in bed suffering from headache. After admission to the asylum the paroxysms of acute mania continued with shorter intervals, varying from three weeks to ten days, and lasting, as a rule, from six to ten days. Besides the mania, he showed a morbid impulse for hoarding. The ebullitions of rage, his great destructive pro- pensity, and his active kleptomania necessitated his isolation. He died of bron- chitis after ten years' residence. The autopsy revealed a deep scar on the left temporal bone half an inch deep, pieces of bone having pressed on the brain sub- stance and caused softening there. The SAME AUTHOR {ibidem) : A. W., age twenty-eight, fell when twenty years old from a height on to his head, from which injury a still visible scar and fissure on the left temporal bone resulted. He showed mental confusion at first, then broke out into violent mania. GUSTAV SPIES (" Zur Casuistik der traumatischen Manie," Wiirzburg, 1869) : Margarete L., age thirty-six, married, mother of three children, was most irascible, though an affectionate mother and industrious housewife. After knocking her head one night in the darkness against a stone, her husband was alarmed at her irascibility, which seemed to increase every day after the slight accident. She became furious, raging, aggressive and voracious. A slight contradiction would result in personal violence. In the intervals she was good-humoured and loquacious. A week after the accident she became so violent that she had to be brought to the asylum. Her destructive, aggressive, and noisy mania soon necessitated the application of the strait-jacket. Her muscular power during these attacks was astounding. In another week she had sitophobia, and great difficulty was ex- perienced in feeding her by reason of her violent resistance. The lucid intervals grew briefer with each attack. After one of these outbreaks of fury she collapsed and died. The post-mortem examination revealed haemorrhage in both middle fossae, more so in the right, and adhesion of the dura mater to the base of the skull. REGINALD HARRISON ("British Medical Journal," 1869) : A dock labourer, age forty-three, had fallen head foremost down a ship's hold, a distance of about thirty feet. On admission he was insensible, cold, and almost pulseless. In the course of the afternoon he partially recovered sensibility, but on being aroused he became exceedingly riotous. On the day following his admission he was in a semi-conscious state. On speaking to him he endeavoured to answer but became exceedingly noisy and riotous. On the third day he became so excited and violent that at times he required two attendants to restrain him. There was 154 THE MENTAL FUNCTIONS OF THE BRAIN no fever. On the fifth day he gradually became completely insensible, and died oc the tenth day. Post mortem it was seen that the temporal lobes at the base were of a dark olive colour, gradually fading into the normal appearance as traced upwards ; they were also much softer than natural, in some parts almost diffluent. Rest of tlie brain free. A Medico-Legal Case, with post moriem-evidence. SERGER (" Allg. Zeitschrift f. Psychiatrie," 1911) : Patient, a man in the fifties, always shy and of a retiring disposition, abstainer, slipped on the ice in the street, blood oozing from nose and ears. Subsequently he suffered from headache and insomnia. The accident was discussed in a Court of Law, his own doctor declaring him incapable of ever resuming work, the insurance experts arguing to prove only temporary disablement. Patient sought further independent advice and, his case being thought serious, he went for a few weeks to Dr. Serger's asylum for observation. It was found that he suffered from constant restlessness, excessive irritability, and an unwarrantable dislike of his family. The Court declared the case to be one of hysteria ; but as he made a murderous attack on his family, the police sent him back to the asylum, where he showed a still greater increase of irascibility than on his first stay. Nearly two years after the accident patient hanged himself with a kitchen-cloth in the lavatory. The post-mortem examination revealed a double fracture in the temporal fossa in the middle line, the membranes being adherent to the bone. Another Medico-Legal Case. Reported in the " Daily Telegraph," London, January 24th, 1902 : This was an action brought by a Lambeth tailor, on behalf of his seven-year-old son, to recover damages from Messrs. J. T. & S., Ltd., for injuries sustained by the boy through the negligence of the defendants' servant. It appeared that a truss of hay fell from the defendants' van on the boy's head and knocked him to the ground. He was picked up and carried home, where he was found to be suffering somewhat severe injury. A lad who worked in the shop after school hours described the child as a lively little boy before the accident ; now he was dull and miserable ; formerly he was well-behaved, now he hit his mother frequently. The father supported this statement, adding that the boy would now take anything and break it, and once he deliberately set fire to a pair of trousers to see them burn. Formerly quiet, well-behaved, he now rushed out into the street, frightening passers-by, picking up stones and throwing them at their heads. He was also given to swearing. The medical superintendent of the Tower Hamlets Dispensary, who attended the boy, expressed his opinion that there had been slight fracture of the base of the skull. During the first week or two there were signs of paralysis, but these symptoms passed away. There was no defence, and the jury assessed the damage at £50. Other Cases of Fracture of Base of Skull with Serious Symptoms. ERNEST TREDINNICK ("British Medical Journal," 1900) : Patient, who sustained fracture of base of skull, killed his wife and then shot himself. The SAME AUTHOR (ibidem) : Patient received a kick from a horse, fracturing skull at left mastoid process. He became maniacal. CHARLES L. DANA (" Journal of Nervous and Mental Disease," 1889) : Kate C, age thirty-two, domestic. Always healthy. No epileptic history. Two years prior to admission patient fell down an air-shaft, distance of thirty-five feet, striking her head. She was unconscious for several days ; was in bed for several weeks. Her friends say she grew difierent in disposition afterwards, and became " queer " in her mind. At times she was very destructive. Eighteen months later supervened chill, three days fever, temporary rigidity of left arm, continuous headache with vomiting. Four months later vertigo, forced move- ments, sudden faUing, always backwards and to the right. When the headache THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 155 was less severe and she grew more conscious she proved very restless and would throw herself out of bed continually, always on the right side of the bed. At last she was tied in. At the autopsy, on removal of the brain, a good deal of blood was seen in the right middle fossa. On the under surface of the right temporal lobe was a focal lesion consisting of softened brain tissue mixed with blood. The lesion involved the third and fourth temporal convolutions in their middle three-fourths. Examples of Injuries to Temporal Lobes leading to Violent Mania and Epilepsy. FRANCIS SKAE {" Edinburgh Medical Journal," 1866) : J. E., age fifteen, son of a farmer. His father's statement was as follows : He was a very intelligent boy until he was five years of age, and at that time he was struck immediately behind the ear by his schoolmaster with a ruler. The blow caused swelling and ecchymosis — no fracture. The same night he screamed out in his sleep ; in the morning a change in his manner and appearance was noticed ; he seemed stupid and silent ; he ceased to speak entirely for six weeks. When he began to speak again he talked nonsense. It is now ten years since he received the blow ; he is often very noisy at night, and he swears a great deal. His father managed him at home until he brought him to the asylum on account of his violence and his dirty habits. He never had any fits or any symptoms of paralysis. On admission he seemed perfectly imbecile, and his bodily condition was weak. He was very noisy at night, swearing profusely, and he was very dirty in his habits. He was put among the noisy patients, and continued unchanged for a year and three months. Then followed a succession of very severe epileptic fits for three days, in one of which he died. The post-mortem examination revealed four drachms of serum in the lateral ventricles, so that it could have been pressure only that caused the symptoms. LAWSON and JkL\JOR ("Lancet," 1876) : B. W., when six years old, was knocked down and run over by a carriage wheel, injuring the whole of the right temple and leaving a depression. Some portion of the bone had necrosed and came away. From that time he had fits. Previous to the accident he was a bright and intelligent boy ; he now became more and more demented. He was given to paroxysms of noisy excitement, in which he fought fiercely and attacked his companions. On his admission he continued aggressive and quarrelsome. He had an offensive discharge from the left ear, and gradually a small abscess formed behind the ear. Two years after admission he had severe haemorrhages from mouth, nose, and left ear, up to a quart of pure blood at a time. He continued querulous and stupid. He died after a frightful outburst of bleeding. Post mortem, there was an old clot in the right temporal lobe, and both grey and white substance were degenerated. There were depressions and rough projections on the petrous portions of both temporal bones and brown staining of both bone and dura mater. The haemorrhage was caused by friction of the larger vessels against the corroded osseous prominences. Case of Slate-pencil in the Head causing Violent Irascibility and Epilepsy. MAX HUPPERT (" Archiv der Heilkunde," Leipsig, 1875) : Carl T., age forty-two, well educated, industrious, and always of a cheerful temperament, received an injury to his head about a year before admission and was thereafter irascible, ill-treating his wife, and in the institution his fury continued. Haematoma auris appeared spontaneously in both ears. A year after he had epileptic fits. He died of oedema of the lungs. On post-mortem examination there was found stretching from the inner wall of the squamous portion of the right tem- poral bone, along the middle fossa to the cornu ammonis, a slate-pencil seventy- three by five millimetres, i.e., three inches long and one-fifth of an inch broad. How the pencil got there could not be ascertained . The appearance was much as if the pencil had been in this situation all the patient's life, and had caused no symptoms until the accident, a 5'ear before the patient's death. Case of Temporal Injury with Irascibility and Aphasia, yet Swearing Fluently. (See remarks on p. 148) : 156 THE MENTAL FUNCTIONS OF THE BRAIN R. BRUGGIA (" Archiv. Ital. par la Malat. Nervos," 1884) : A fireman, age thirty-five, was hit in an explosion by the point of a wooden rod so violently in the left temporal region, about two to three millimetres above the external opening of the ear, that the bone was indented to the extent of admitting the point of a finger. Fourteen days' stupor followed this accident, after which he was unable to speak, though he understood everything that was said to him, and easily got into a temper, in which he could use abusive words quite fluently, which he could not articulate when quiet again. He could reproduce melodies without a mistake. Another Similar Case. M. JOWETT ("Western Journal of Medicine," 1868) : Patient received injury to temporal lobe, became aphasic, but could swear when in rage. Example of Temporal Injury followed by Character Changes, apparently only temporary. CHARLES GIBBS (" International Clinics," 1902) : G., a young officer, received an extensive wound at the base of the skull and in the neck, which had been sown up. In spite of the severity of the wound, he fought on. He reached the Langman Hospital forty-eight hours after. Blood was oozing from the wound. The stitches were removed and the whole extent of the wound was explored. There was considerable injury to the structures of the neck, the main mass of the mastoid process and the adjacent petrous bone had been blowTi away. The upper part of the wound was full of brain matter reduced to a sanguinary pulp. At least one ounce was removed at the first dressing. This was the wound of exit ; the wound of entrance was about four inches above this and a little behind it. It was an ordinary Mauser puncture of three-eighths of an inch in diameter. There was complete facial paralysis on this side and complete deafness. The general condition of the patient was extremely good ; he was perfectly conscious, understood what was said to him, answered properly, and took his food well. The only mental change was in his temper. This could hardly have been worse. He grumbled at everything and everybody. This irascibility was quite abnormal, for he was well known as a man of great amiability and very popular with his regiment. Since his recovery of health the irascibility has completely gone, and he is once more of charming amiability. The wound was surgically attended to and in a few weeks healed up. The author concludes : " This case is interesting as showing what a grave amount of destruction the brain is able to sustain without losing any of its functions." But both the examination and the history given are incomplete. On inquiry, it appears the man has not done so well. Three other cases are given by the author where nothing mentally has been observed. Other Examples : CHARLES PHELPS, 42 cases. New York Medical Journal, 1893. O. HERPIN, several cases. Bulletins de la Societe Anat. axid Progr^s Medical, 1876. JAMES ROSS, several cases. Diseases of the Nervous System, 1883. R. V. KRAFFT-EBING, several cases. Friedreich' s Blatter, 1868. PAUL SCHULLER, several cases. Psychosen nach Kopfverl. 1882. BERNHARD BECK, several cases. Die Schddelverletzungen, 1865. LANDERER and LUTZ, several cases. Christophsbad Asylum Reports, 1878. L. SCHLAGER, several cases. Zeitschr. d. Ges. d. Aerzte z. Wieu, vols. vii. and viii. HARTMANN, several cases. Archiv f. Psychiatric, 1884. LIEBER and BEDSTUBNER, ibidem, vol. xv. HERMANN DEMME, several cases of bullet wounds. Militdr-Chirurg. Studien, Wiirzburg, 1864. BAX, bullet wound. Fricke's Zeitschrift, vol. viii. THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 157 R. W. AMIDON, bullet wound. Journal of Nervous and Mental Disease, 1880. J. CHRISTIAN, bullet wound. Archives de Neurologie, 1889. Sir W. S. SAVORY, British Medical Journal, 1869. SHAW and CRIPPS, ibidem, 1890. W. H. BATTLE, ibidem, 1890. J. LANE, ibidem, 1872. J. RUSSEL, ibidem, 1865. FLEMMING, homicidal case. Sachsenberg Heilanstalt Bericht and Allg. Zeitschrift f. Psychiatrie, vol. ix. W. J. MICKLE, two homicidal cases. Journal of Mental Science, 1881 and 1885. J. R. WHITWELL, ibidem, 1891. W. B. FOX, ibidem, 1891. C. A. T. BILLROTH, Chirurgische Klinik, 1871. H. VOPPEL, Allg. Zeitschr. f. Psychiatrie, 1857. A. PICK, Prager Mediz. Wochenschrift, 1880. J. WAGNER, Jahrbuch f. Psychiatrie, 1889. VAN DEVENTER, Psychiatr. Bladen, 1887. ZIERL, Friedreich's Blatter f. gerichtl. Med., 1882, THOS. CLAYE SHAW, Archives of Medicine. 1882. F. LALLEMAND, Recherches Anat.-Path. sur I'Encephale. L. F. ARNAUD, L'Encephale, 1888. G. J. GUTHRIE, Injuries to the Head affecting the Brain. ALCOCK, Lancet, 1877. G. THOMSON, Brain, 1884. DANIEL CLARKE, American Journal of Insanity, i88i. SCHAFER, Centralblatt f . Nervenheilkunde, 1881. JULIEN TELLIER, Traumatismes du Crane, 1890. VIOLENT MANIA FOLLOWING TUMOURS OF TEMPORAL LOBES KAPLAN ("Allg. Zeitschrift f. Psychiatrie," 1897) : A nursemaid, age thirty-two, sufiered for about four years from great irritability and sudden attacks of anger, after which she sometimes became aphasic. She suffered from loss of consciousness and attacks of giddiness for twelve months. During the two years she was at the asylum she proved very excitable without cause, exaggerated little matters, and was continuously quarrelling with the other patients. She had outbursts of fury and made obscene remarks. During the last weeks of her life she suffered from headache, giddiness, and vomiting. The necropsy revealed a tumour occupjang nearly the whole base of the left temporal lobe. E. KLEBS (" Prage Vierteljahrschrift," 1877) : A man, age thirty-three, whose mental sjonptoms were violent anger with paroxysms of fury, had a neuroglioma in left temporal cortex. LINDSTROM (" Hygiea," vol. xviii.) : Male, age fifty-five, had fracture of temporal bone when twenty years old, which healed completely. Paroxysms of fury every three or four weeks. Headache in right temporal area. Vomiting. Post mortem, a tumour was found in right temporal lobe adherent to dura mater. H. SCHULE (" Sectionsergebnisse bei Geisteskranken," Leipsic, 1874) : Jacob Hock, age fifty-six, admitted for furious mania with impulses to violence and destruction, tearing whatever was within reach. Patient developed enormous gluttony. His speech was most obscene. Post mortem, two gummata were found at the tip of the left sphenoidal lobe in the thickened dura mater, adhering to the WILLIAM BOYD and STANLEY HOPWOOD (" Lancet," 1913) : A man, age forty-seven, by trade a moulder, suffering from chronic mania, a useful and capable worker in the asylum, though weak-minded and having auditory hallucinations. He had periodic attacks of noisy excitement and at times became very abusive. He died after ten years' residence. Post mortem, the greater part of the left temporal lobe was replaced by a large cyst. Remainder of brain normal. 158 THE MENTAL FUNCTIONS OF THE BRAIN Case of Tumour of Temporal Lobe mistaken for " Hysteria." A. HUGHES BENNET (" Brain." 1878) : Miss A., a young lady, age sixteen, at the first consultation complained chiefly of blindness and loss of power in her lower extremities. Father had suffered from acute mania. Patient in her extreme youth exhibited unusual sharpness and intelligence, generally exercised for mischievousness or destructive purposes. She was always a " very naughty child," who took a special delight in annoying and playing mischievous tricks on her companions and relatives. She was unusually developed for her age, physically and mentally, and she still retained her reputation for wilfulness, cunning, and bad temper, although she could make herself amiable and agreeable if she liked. She had been expelled from school for misconduct. Six months prior to the consultation, being apparently in robust health, while in an angry fit and sulking after correction for misdemeanour, she became suddenly blind. It was thought she was malingering, and, indeed, a few days afterwards, she recovered her sight. She had a second attack of blindness, and in addition deafness, which lasted some weeks, when she regained her hearing, but not her sight. Several physicians diagnosed " hysteria." Four months later she also lost power over her lower hmbs. Every now and then she had attacks lasting from one to three hours, which had all the appearance of hysterical fits, involving shouting, laughing, crying, throwing herself about, striking the nurse, etc. Later on she became restless and greatly excited, chiefly at night, and frequently alarmed the household by crying aloud and getting out of bed. The excitement continued to increase, until on the third day there supervened mind-wandering and delusions. She was now totally blind, deaf, and could not stand on or move her hmbs. She did not know anyone. She complained of violent headache. On the fifteenth day she became unconscious and wildly delirious, until she died on the twenty-fourth day. At the autopsy all the organs were found healthy, except the brain. A tumour, the size of a hen's egg, was discovered in the medullary substance of the temporo-sphenoidal lobe, highly vascular, with extravasation of blood on its surface. Another Case of Tumour of Temporal Lobe mistaktn for " Hysteria." ALEXANDER BRUCE (" Brain," 1883) : L. M., age forty-five, single, previously a nurse, until two years prior to con- sultation had been remarkably healthy, of a cheerful and kindly disposition. Then it was first noticed that she had become nervous and excitable. Six months later patient began to grow very selfish, irritable, and jealous of her sisters, and had grown so passionate as to be almost unbearable at home. Then for nine months she seemed to be in perfect health, and held a situation as nurse. Then, however, she began to get excitable, and to quarrel without cause with her fellow-servants. Finally her excitement became so great that she alarmed everyone by rushing about the house at night screaming. Two physicians diagnosed "hysteria," and a surgeon thought her simply excitable and recommended her to go to the country for a-time. There she had her usual fit of laughing and cr^dng, especially the latter, for no apparent reason, and the medical man who had been summoned, again assuming hysteria, recommended treatment by " firmness with kindness." Two months later she had what appeared to be an attack of paralysis, but what was thought by the physicians to be either functional or " shamming." She was removed, however, to the infirmary, where she died the following month. The autopsy revealed a tumour extending from the tip of the left temporo-sphenoidal lobe to the junction of the anterior with the middle third of the pons, pushing the convolutions of the temporo-sphenoidal lobe outwards and pressing on pons and medulla. More Cases of Temporal Tumours mistaken for " Hysteria." Sir W. T. GAIRDNER (" British Medical Journal," 1S77) : Woman, age thirty, diagnosis hysteria, tumour left inferior temporal convolution. BRAULT and LOEPER (" Arch. Gen. de Medecine," 1900) : Case of mistaken hysteria. Tumour right inferior temporal convolution. THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 159 BALL, " Buffalo Medical Journal," 1898 : Girl, age sixteen, supposed hysteria ; tumour right temporal lobe. Temporal Tumour with Mania and Convulsions. JACOB WEISS (" Wiener Medizinische Wochenschrift," 1877) : H. D. F., a potter's assistant, age fifty-one, was on admission in a state of acute maniacal fury. He tore the clothes off his body, jumped and rolled about on the floor, shouting, kicking, biting, and rendered a medical examination impossible. It was ascertained that patient had clonic convulsions of his right extremities for a year, and that the fits during the last few weeks had continued daily. The maniacal excitement went on day and night, patient striking the door so violently with his hands and feet as to produce numerous excoriations. In the end he got exhausted, fever set in, strabismus divergens, and facial paralysis on left side. He died of pneumonia a month after admission. The post-mortem examination revealed a tumour, size of a walnut, embedded in the left temporal lobe, and extending along the base to anterior part of the pons and left crus. Tumour of Temporal Lobe with Violent Mania and Epilepsy. T. S. CLOUSTON (" Journal of Mental Science," 1872) : J. R., male, age thirty-eight, married, butcher. No hereditary predisposition. Had shown symptoms of insanity for four years. His first mental symptoms seem to have consisted of a change in temper, great irritability, and an altered affection for his wife and family. His first bodily symptoms were intense headache, slight deafness and gradually increasing blindness. He had been getting mentally much worse, being excessively irritable, violent towards his wife and daughters, very abusive and foul in his language, and then accusing his wife of all such violence. During twelve months before admission he had had several epileptic attacks. On admission he proved sharp and intelligent, and had no delusions ; the gait was that of a tipsy man. He was quite bUnd, and deaf in his right ear. In nine months his legs were paralysed. It was noticed during the first fortnight that on the very slightest provocation he became wild with passion, completely losing control over himself and capable of doing any violence to those about him. The excessive irritability with violent paroxysms of passion, often coming on without cause, were his chief mental characteristics during the remainder of his life. He died ten months after admission. Post mortem, a tumour was found attached to the right temporal bone, having disorganised the internal ear of that side, and having caused complete softening of the temporo-sphenoidal lobe by pressure. More Ttimours of Temporal Lobes with Violent Mania and Epilepsy. J. B. TROWBRIDGE (" Neurologisches Centralblatt," 1881) : Acute mania and epilepsy. Cyst in right temporal lobe. B. M. McDOWALL (" Ri vista di Freniatria," 1889) : Epileptic mania, very dangerous, homicidal. Tumour of left temporal lobe and hippocampus. RUSSELL ("Medical Times and Gazette," 1873) : Maniacal excitement, threatening, epilepsy. Post mortem, cyst middle of base of left temporal lobe. KAPLAN (" Allg. Zeitschrift f. Psychiatric," 1898) : Spinster, age thirty -two, bad-tempered, abusive, quarrelsome, later epileptic. Sarcoma of left inferior temporal convolution. Other Examples of Temporal Tumours with Violent Mania, and most of them with Homicidal Tendencies. MILLS and McCONNEL, Journal of Nervous and Mental Disease, 1895. F. X. DERCUM, ibideyn, 1912. S. J. SHARKEY, ibidem, 1889. J. B. TROWBRIDGE, ibidem, 1891. J. RORIE, Journal of Mental Science, 1890. i6o THE MENTAL FUNCTIONS OF THE BRAIN B. M. McDOWALL, ibidem, 1881. W. H. PACKER, ibidem, 18S2. CONOLLY NORMAN, two cases. Ibidem, 1890 and 1893. J. RUSSEL, Medical Times, 1875. Sir JAS. CRICHTON-BROWNE, British Medical Journal, 1873. Sir W. T. GAIRDNER, 2 cases. Ibidem, 1873 and 1877. J. A. ARBUCKLE, Glasgow Medical Journal, 1876. Sir SAMUEL WILKS, Guy's Hospital Reports, 1866. H. M. HURD, American Journal of Insanity, 1896. OTTO SNELL, Allg. Zeitschrift /. Psychiairie, 1875. A. RICHTER, ibidem, 1883. J. JENSEN, ibidem, 1889. W. FRANKEL, ibidem, 1896. E. K. HOFFMANN, Zeitschrift f. rat. Medizin, 1869. K. OPPENHEIM, Archiv f. Psychiairie, 1877. M. HUPPERT, Archiv der Heilkunde, 1875. ROUSSEAU, 2 cases. L'Encephale, 1888. E. CHAMBARD, ibidem, 1881. H. LUTZ, Bayr. Aerztl. Intelligenzblatt, 1864. GEOFFREY, Annates Medico-Psychologiques, 1865. BALL, ibidem, 1876. C. BOUCHET. ibidem, 1853. C. BAUZE, Jahrbuch f. Kinderheilkunde, 1876. Cases of Tumours in Lateral Ventricles, etc., with Oedema of Temporal Lobes. ALFRED H. RL^RTIN, British Medical Journal, 1875. W. B. RANSOME, Brain, 1895. J. P. FALRET, Bullet, de la Societe Anatomique de Paris, 1866. N. FRIEDREICH, Intracranial Tumours, Wiirzburg, 1853. M. ROSENTHAL, Med. Jahrb. der Ges. d. Aerzte z. Wien, 1882. A. HOLLANDER, Jahrbilcher d. Psychiatric, vol. iii. F. K. STAHL, 6 cases. Allg. Zeitschrift f. Psychiatric, 1869-1873. C. FURSTNER. Archiv f. Psychiatric, 1875. GOTTFRIED JEHN, 3 cases. Ibidem, 1878. EXAMPLES OF INFLAMMATION AND SOFTENING OF THE TEMPORAL LOBES WITH VIOLENT AND HOMICIDAL MANIA H. SCHULE (" Sectionsergebnisse bei Geisteskranken," Leipsic, 1874). Three cases, of which one is quoted herewith : M. M., age thirty, was admitted on account of an increasing mental excitability and intense headache. He soon became violently maniacal, with a stormy motor restlessness, shouting, and destroying everything in the room, and threatening those approaching him. Opium reheved him only temporarily, then the scenes of violence and destruction began anew. Pulse and temperature arose proportionately with the degree of excitement. Much grinding of teeth. No paresis. Two months after admission he died from convulsions. Post mortem, the anterior part of the temporal lobe and the whole of its base was found softened. Basal ganglia not involved. B. ASCHER ("Allg. Zeitschrift f. Psychiatric," 1893) : A man, age forty-five, was admitted on account of violent mania. The post- mortem examination revealed softening of both temporal lobes, more marked in the left than in the right. J. MacKENZIE BACON (" Journal of Mental Science," 1869) : William G., age fifty-seven, kept well till within a few days of his admission into the Cambridgeshire Asylum, when he became noisy and excited. When admitted he was in a state of restless dehrium. He was fed with the greatest trouble, resisting all efforts in a bUnd fury, without any particular object. He died after eleven days. On removing the dura mater there was thick greenish lymph, limited to the left middle fossa of the base of the skull. THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN i6i FURSTNER and STUHLINGER (" Archiv f. Psychiatric," 1886) : Reibold, a married woman, age forty-seven, irascible from childhood, in contin- uous conflict with her husband. On admission noisy, abusive, aggressive. Died after eight months. Post mortem, the left temporal lobe was bulging, and both temporal lobes were tougher than usual. They had a yellowish discoloration and numerous granules on their surface, the size of pins' heads. CLOVIS GALLOPIN (" Annales Medico-Psych.," 1879) : Louis Cheval, age sixty-one, admitted for violent mania, cried and shouted all night long. Six days after found dead in bed. Post mortem, softening of left temporal lobe was found. WM. JULIUS MICKLE ("Journal of Mental Science," 1880). Four cases, of which one is quoted herewith : J. M., soldier, age thirty-three, developed suddenly homicidal impulses. On admission restless, meddlesome, irritable, quarrelsome, foul and obscene in his language, and dirty in his habits. Post mortem, marked changes in the middle fossae, where there was a false membrane and the temporo-sphenoidal lobes were eroded. There had been tenderness over the temples during his illness. T. DUNCAN GREENLEES ("American Journal of Insanity," 1887). Two cases, of which this is one : Hannah Eliza F., age fifty-six, single, was suffering from acute mania, but remained coherent. Died in an apoplectic seizure after five years' residence. Post mortem, softening of the left temporo-sphenoidal lobe was found, and blocking of left meningeal artery. Case of Destruction of Left Temporal Lobe without Sensory Aphasia. ADOLF KUSSJVIAUL (" Berhner Klinische Wochenschrift," 1885) : Woman, age sixty-three, could hear quite well, read letters and newspapers, and spoke German and French fluently. Nothing was remarked of her mental condition, save that for the last two years her character had changed. She was selfish and quarrelsome. She died of abdominal trouble. On examination there was found wanting the greater part of the left temporo-sphenoidal lobe, including the half of the Wernicke's sensory speech centre (she was right-handed), without either the comprehension or the utterance of words or the power of hearing in either ear being injured. Lesion of Temporal Lobe with Irascibility. ALBERT M. BARRETT (" Journal of Nervous and Mental Disease," 1910) describes the case of a man, named Taft, a good business man, who enjoyed perfect health till he was about forty-five. Then he became weak in his legs. He gave up business at fifty-two. " For some years previous there had been developing an increasing crankiness in his disposition and he showed a number of eccentricities of conduct, such as doing little things to annoy his family — as shouting, whistling, and slamming doors. In more recent years these peculiarities became more pro- nounced." Otherwdse he retained his mental capacity up to the age of sixty-seven when he became word-deaf and lost the use of his legs. " Throughout his illness he wa3 irritable and fault-finding." Post mortem, the posterior portions of the right and left first temporal convolutions showed signs of softening and were sunken inwards. Other Cases of Softening of Temporal Area with Violent and Homicidal Mania. BYROM BRAMWELL, Edinburgh Medical Journal, 1879. R. B. MITCHELL, ibidem, 1883. M. MARIANI, Archiv. Ital. per le Mai. New., i886. RASORI, Centvalblatt, vol. xiv. STUCKLE, A llg. Zeitschvift f. Psychiatrie, vol. xiii. H. VOPPEL, ibidem, vol. xiv. C. FROHLICH, two cases. Ibidem, 1875. L. WILLE, ibidem, 1875. Vol. ii.] M i62 THE MENTAL FUNCTIONS OF THE BRAIN G. H. BERGMANN, ibidem, vol. ui. TH. ZACHER, Archiv f. Psychiatrie. 1888. A. ALZHEIMER, ibidem. 1897. M. KOPPEN, two cases. Ibidem, 1896. J. B. TROWBRIDGE, Journal of Nervous and Mental Disease, 1891. CHARLES L. DANA, ibidem, 1889. O. KORNER, Berl. Klinische Wochenschrift, 1885. H. LUTZ, Bayr. Aerztl. Intelligenzblatt, 1864. J. LUYS, L'Encephale, 1891. LABORI, Bullet, de la Soc. Anatom., 1867. J. CHRISTIAN, Annates Me'dico-Psychologiques, 1874. T. R. GLYN, British Medical Journal, 1878. H. ZINGERLE, Journal f. Psych, und Neurologie, 191 1. ANGLADE, Gazette Medicate de Bordeaux, 191 1. WM. BOYD and S. HOPWOOD, Lancet, 1913. LAUDER LINDSAY, Murray's Royal Asylum Report, i860. KENNETH McLEOD, Journal of Mental Science, 1861. F. NEEDHAM, ibidem., 1872. W. R. WOOD, ibidem, 1884. BLEYNIE, Dissertation sur I' Inflammation du Cerveau. T. D. GREENLEES, two cases. American Journal of Insanity, 1887. ADOLPH MEYER, ibidem, 1895. Sir G. H. SAVAGE, Brain, 1879. A. ROSENTHAL, two cases. Centralblatt f. Nervenheilkunde, 1884 and 1889. Examples of Hcemorrhage into Temporal Fosses. H. VOPPEL, two cases. Allg. Zeitschrift f. Psychiatrie, vol. xiv. A. EICHHOLT, ibidem, 1885. E. KUNDT, three cases. Ibidem, 1894. T. KREBS. ibidem, 1895. E. K. HOFFMANN, Vierteljahrschrift f. Psychiatrie, vol. ii. H. T. TILING, St. Petersburg Med. Wochenschrift, 1879. M. A. FOVILLE, Annates Medico-psychologiques, 1871. J. B. ANDREWS, American Journal of Insanity, vol. xxv. T. KIRKBRIDE, ibidem, 1879. F. L. A. KELP, Deutsches Archiv f. Klin. Medizin, 1872. A Medico-Legal Case of Homicidal Mania and Epilepsy with Post Mortem. STUCKLE ("Allg. Zeitschrift f. Psychiatrie," vol. xiii.) : J. D., an epileptic, married, father of three children, was much ill-treated in his youth by his father, who was of violent temper. He often lost consciousness after severe chastisement. Patient studied well, was good-natured, sociable, industrious, and economical. Epileptiform convulsions commenced in his twentieth year, and simultaneously with them his character changed. He became less sociable, irascible, and inasmuch as his business brought him into pubhc-houses, his irascibility was thought to be due to drink. When twenty-six years old he had an attack of mania furiosa, lasting several days, during which he was restrained. The attacks recurred every three or four weeks. A prwate physician who took charge of him seemed to have cured him for a time. He married shortly after this cure. The year after the attacks of rage recurred and grew more frequent. They were accompanied by oaths and threats against his nearest relatives. He was frequently restrained. In his lucid intervals he was very rehgious. Two years after marriage, now in his twenty-ninth year, he locked a woman, whom he employed in business, in his room, where a prayer-book and some butcher's knives were lying on the table, and told her that she would have to suffer with her life for her want of piety, and that he was destined to kill her. Her cries for help saved her life, but she lost an eye in the adventure. The raging maniac was handcuffed and locked up. The following year he was again sent to a private asylum for his repeated attacks of mania, and was^once more discharged as normal. Immediately on his arrival home he THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 163 threatened his brother-in-law, was again arrested and again sent to a private asylum, and then to another, and finally died in the State asylum in his thirty- sixth year. Post mortem, osteophites were found in the middle fossa of the skull, and the lateral ventricles were very much dilated. A Case of Pyromania and Homicidal Mania and Epilepsy with Post Mortem. FR. MESCHEDE (" Allg. Zeitschrift f. Psychiatric," 1873) : Natalie X., an epileptic girl, age seventeen. She showed a tendency to mischief a year before her admission. She stuck a knife into the lungs of her father's horse ; another time she cut up a perfectly new dress, and another time unchained a dog known for his viciousness. She frequently laid fire, and on each occasion said she could not resist the impulse : she felt she had to do it. She learnt well at school, but had to be removed because of her interrupting the lessons. Her father thought her a wicked child and punished her, but she did not appear to feel the chastisement. An aunt of hers in another town took charge of her, until she was caught one night attempting to pierce the eyes of the children with a hairpin. After the injury was done she confessed that an inner voice prompted her to do so. She made several more attempts to set on fire. Several experts had examined her, and advised her being consigned to an asylum. At the institution she had a mania for taking hold of burning objects, and collected all the matches. During the Christmas festivities, when supervision was somewhat relaxed, for precaution sake her bed was examined, and a collection of matches was found in it. Even when she was free from fits she was very noisy and aggressive, beating, kicking and scratching other patients. She kicked a can of oil over, tore numerous dresses, and notwithstanding the supervision, succeeded in hiding objects with which she could lay fire. She had otorrhoea dextra, which increased latterly very much. She died of miUary tuber- culosis. Altogether she succeeded in causing fires six times. The autopsy revealed a prominent osteophite in the form of a crest in the middle fossa. The arachnoid membrane was turbid and remarkably thick at the temporal lobes, which were firm and hard. Another Case of Epilepsy with Homicidal Impulses. The SAME AUTHOR (ibidem) : Martin Kluszikowski, an epileptic, age eighteen, with perfect calm, vrithout motive or cause, loved to injure people. He had the mien of a cat ; the noiseless, elastic tread and treacherous glance, but otherwise he seemed harmless. His derangement showed itself mainly in impulses of harmful mischief and in attempts to cause personal injury. They were not accompanied or preceded by feelings of rage or anger ; not done bhndly nor noisily — as is common with epileptics ; they were committed slyly, as if in gratification of some morbid impulse or desire. He appeared conscious that he was doing wrong. The cat-like seizure of opportunities to do wrong made him highly dangerous. Thus, a workman was putting down a file for a moment, which the patient promptly seized, and stabbed another patient with it in the back. The autopsy revealed basal meningitis, limited to the middle fossa. All the membranes were adherent in this region, both to the skull and brain, and the comu ammonis was sclerotic. Other Cases of Osteophites in Temporal Region with Epilepsy and Violent Mania. LUDWIG MEYER (" Archiv f. Psychiatric," 1872) : Heinrich S., joiner, age thirty-six, married, fell into the street from a window he was repairing. He seemed uninjured except for a superficial contusion, but from the right ear flowed fluid, and on recovery from the shock there was impairment of hearing. Later on he had difficulty of hearing also on the left side. Some weeks later he had general convulsions. His character changed and he was easily roused to violence, attacking his wife and friends, and destroying the contents of a room. At the institution he so often attacked his fellow-patients that he had frequently to be isolated. He had an apoplectic stroke and died four years after the accident. Post mortem there were several large and sharp exostoses in the right middle fossa with locahsed pachymeningitis. 164 T^HE MENTAL FUNCTIONS OF THE BRAIN T. S. CLOUSTON ("Journal of Mental Science," 1875) : T. M., thirty-eight years old, admitted six months after severe epileptic fits, coherent, but intensely irritable, would strike out at anyone on the slightest provoca- tion or contradiction. Irritability greatest after the fits. Used foul abuse and most vituperative language, if he did not strike, at the refusal of a request. Post mortem, osteophites in temporal bone, dura thickened, and lower parts of temporo- sphenoidal lobes atrophied. The SAME AUTHOR {ibidem) : D. G., engineer, age thirty, five years an epileptic, after a fall on the left side of the head in a ship. He had been very dangerous and violent to those near him, In the asylum very irritable and violent in an impulsive way. Post mortem, irregular excrescences in squamous portion of left temporal bone, membranes and brain matted together in this region by fibrous tissue. Temporal convolutions atrophied. Sir FREDERIC BATEMAN (on "Aphasia," London, 1890) : C. G., a gentleman, age thirty-six, subject for many years to great mental excitement, had to be placed in asylum. There he had convulsions, followed by right hemiplegia and aphasia. Post mortem, exostosis found in middle fossa, with membranes adherent. Other Examples of Temporal Lesions with Violent Mania and Epilepsy. ZOHREB, Allg. Zeitschyift f. Psychiatrie, 1886. FEITH, ibidem, 1867. OTTO SNELL, ibidem, 1875. F. LtJHKMANN, ibidem, 1896. Sir SAMUEL WILKS, Guy's Hospital Reports, 1866. A. CULLERRE, Annates Medico-Psychologiques, 1890. M. FOVILLE, ibidem, 1882. W. J. MICKLE, Journal of Mental Science, 1881, S. W. D. WILLIAMS, ibidem, 1869. T. B. WORTHINGTON, ibidem, 1880. W. R. WOOD, ibidem, 1884. FRANK HAY, ibidem, 1895. A. TAMBURINI, Rivista Sper. di Freniatria, vol. v. C. BOUCHET, several cases. De V i. pilepsie . BOURNEVILLE and D'OLLIER, two cases. Recherches sur I' Epilepsia, Panis, 1881. BECK, Archiv f. Psychiatrie, vol. xv. T. CRISP ENGLISH, Lancet. 1904. J. S. BOLTON, several cases. Journal of Mental Science, 1905. EXAMPLES OF CHRONIC MIDDLE EAR DISEASE WITH VIOLENT AND HOMICIDAL MANIA Observation by the Author. Medico-Legal Case. A highly esteemed and widely-known professional man, a devoted husband and father, killed one day his wife and both his daughters, ten and thirteen years respec- tively, by cutting their throats. He then took his own life. There were signs of a struggle with the victims, but no evidence that there had been a quarrel beforehand. Indeed, his brother had spoken to him a few hours before, and at the inquest declared that he found him in full possession of his reason and with his usual amiable character. Nor had he any cares or sorrows. Patient suffered from a chronic abscess in the ear, for which he had already once been operated upon, and for which he was still under treatment. The inflammation had extended to the adjacent brain. Another Medico-Legal Case. K. CRAMER (" Gerichthche Psychiatrie ") : THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 165 The wife of a working man, age thirty-two, family history normal, suffering from disturbance of the inner ear, after a confinement in which she lost a great deal of blood, heard voices : " You must cut the throats of your children." The voices became more powerful, until they took entire possession of her, so that she could no longer resist, and, with a large latchen knife, she cut the throats of her children, of whom she had so far been the loving mother. Still A nother Medico-Legal Case. "American Journal of Insanity," vol. v., p. 34. : William Freeman, a servant. Several members of his family were insane. At the age of sixteen he was sentenced to five years' imprisonment for stealing a horse. It was the general opinion that he was innocent of the charge. Whilst in prison, Freeman was struck a severe blow over the side of the head, which caused a chronic purulent discharge from the ear and deafness. The unjust imprisonment seemed constantly to prey on his mind, and when he left the prison at the expiration of his sentence he sought compensation, but in vain. Remuneration with him was the one idea. He enjoyed three years' liberty. During this time he is reported never to have spoken much and to have spoken only when addressed ; never to have asked any questions, and to have answered very briefly those put to him. He was now twenty-two years of age. One evening he armed himself with a common butcher's knife and left his lodging, no one knowing for what purpose. After examining two or three premises he finallj^ selected those of Mr. Van Nest as the proper place to begin " his work," as he termed it, and there massacred Mr. Van Nest, his wife, one child age two years, and Mrs. Wyckofi, age seventy. He stabbed another man, Mr. Van Arsdale, in the chest, who subsequently recovered. In the affray he entered every room in the house, both above and below, but took nothing away. He went to the stable, unfastened and mounted a horse, and was some rods from the scene of devastation in the incredibly short period of not more than five minutes from the time of entering the house, as was proved in evidence. Three days afterwards he was committed to jail to await his trial. The excitement caused by the killing of a well-known family, the character of the act, the plea of insanity which was made in defence, the protracted trial, the reputation of the distinguished counsel (Van Buren), and the number and standing of the medical witnesses called all conspired to give the case an unusual interest. Freeman died of phthisis while under trial. The post- mortem examination revealed caries of the inner part of the petrous portion of the left temporal bone. The dura mater covering this portion of the skull was red and congested, and the internal structure of the ear was mostly obliterated. There was also a collection of fcetid pus in the cavity of the bone having no connection with the external ear. These changes, it was proved, were consequent upon the injury Freeman received when an inmate of the State prison ; he was struck on the head with a board, the blow splitting the weapon into fragments. The medical opinion was that this injury was the cause of the diseased condition of the brain and of the violent and sudden derangement for which the defendant was on trial. Case of Middle Ear Disease in a Boy leading to Violence and Destructive Tendencies^ E. BOUCHUT (" Gazette des Hopitaux," 1877) : The wife of an English naval officer brought to him her boy, age six. Wlien three years old the boy had measles and chronic bronchitis. Two years later he was sent to Nice for cure. He there had scarlet fever, and after recovery otorrhoea of the left side, which had lasted for three months. Since this otorrhoea he heard indistinctly with that ear, suffered with his head, and had nervous crises, several in a day and even during the night. No vertigo nor loss of consciousness, no vomiting. He became wild, yelled furiously, and threw himself on his mother, kicking her and striking her with his fists. His attacks were made as if he meant to kill her. He smashed everything he could lay his hands on. After that he became calm again, began to cry, embraced his mother, until the next storm broke out shortly afterwards with exactly the same symptoms. The noise he made was so great that the hotel people would not allow his mother to stay any longer, and she had to seek apart- ments elsewhere. She was recommended to reside with a medical man, and during I66 THE MENTAL FUNCTIONS OF THE BRAIN residence there the same violent scenes occurred as before. Before the treatment was concluded the mother returned to England with her son. Other Examples of Violent Mania due to Ear Disease. E. GRISSOM, American Journal of Insanity, 1877. G. C. BABLETT, two cases. Ibidem, 1877. H. SPITTA, homicidal. Medico-legal case. Praktische Beitrage zur Ger. Arzil. Psychologie. JANSEN, Berliner Klinische Wochenschrift, 1891. L. SCHLAGER, Zeitschrift d. Ges. d. Aerzte zu Wien, vol. xiii. HOMER, Monatsschrift f. Ohrenheilkunde, 1863. WM. MacCORMAC, Lancet, 1886. G. FABRI, Italia Medica, 1883. H. SCHULE, three cases. Handbuch d. Geisteskrankheiten, 1878. H. KUKARZEWSKI, Progres Medical, 1894. W. H. BENNETT, Dublin Quarterly Journal of Medical Science, 1871. A. BABINSKY, Languedoc Medical, i8gi. EDWIN W. DAY, two cases. Annals of Otology, 1911. In view of the above cases, the frequency of homicide in ear disease is not surprising. Recently I have collected a number of cases committed by deaf-mutes. They have certain features in common. As in most of the cases quoted, the murder is committed with unwonted brutality, more than one person may be attacked, sometimes perfect strangers, and not infrequently the guilty person attempts suicide after the deed. Still, in strict accordance with the law, these afflicted persons are sentenced to death or varying terms of hard labour. A FEW EXAMPLES OF SENSORY APHASIA WITH VIOLENT MANIA GIUSEPPI SEPPILLI ("Rivista SperimentaH di Freniatria," 1884) : A widow, age fifty-one, entered the hospital in a state of violent mania. She sufiered from word-deafness, though her hearing was perfect. Her mental faculties after the subsidence of the attack seemed unimpaired. Post mortem, the mem- branes were adherent over the first and part of the second convolutions of the left temporal lobe. ALBERT ROSENTHAL (" Centralblatt f. Nervenheilkunde," 1886): Engineer, age forty-three, suffered from sensory aphasia. Two years later violent maniacal excitement. He was easily aroused to anger, became dangerous and destructive. Post mortem, the left temporo-sphenoidal lobe, particularly the inferior convolution, was so softened that it was washed away by a jet of water. The SAME AUTHOR (ibidem, 1889) : F. K., age thirty-nine, had an apoplectic stroke, followed by hemiplegia on right side, sensory aphasia, inabihty to count ten, though formerly a good arithmetician. Agitated mental condition. Left temporal lobe, especially superior and middle temporal convolutions, atrophic. L. BIANCHI ("La Emiplegia," Naples) : Cerbone J., age sixty-one, a working man of low type, always fighting, violent, quarrelsome, woke one morning with sensory aphasia. Though hearing well, he could not understand a single word spoken. The upper half of the left temporal lobe was found softened. Other Examples of Sensory Aphasia with Violent Mania. H. LIEPMANN, homicidal. Neurologisches Centralblatt, 1900. LEOP. LACQUER, Neurologisches Centralblatt, 1888. BANCROFT, American Journal of Insanity, 1879. W. L. WORCESTER, ibidem, 1896. SCHAFER, Centralblatt f. Nervenheilkunde, 1881. M. BERNHARDT, ibidem, 1882. THE EMOTION OF ANGER AND ITS CEREBRAL ORIGIN 167 A. PICK, Afchiv f. Psychiatrie, 1892. E. BISCHOFF, three cases. Ibidem, 1889. L. BRUNS, Allg. Zeitschrift f. Psychiatrie, 1892. G. HEBOLD, ibidem, 1894. J. FRITSCH, Wiener Mediz. Presse, 1879. F. BAIZER, Gazette Medicale de Paris, 1884, MILLS and McCONNELL, homicidal. Journal of Nervous and Mental Disease, 1895- A. M. BARRETT, ibidem, 1910. CASE OF ABNORMAL DEVELOPMENT OF THE TEMPORAL LOBES WARREN L. BABCOCK ("State Hospitals' Bulletin," New York, 1896) : F. C, female, age thirty-one, single, habits good, tendencies destructive and criminal in character. During childhood she was eccentric and unruly, markedly disobedient, perverse in her tastes, irritable on slight provocation, and when angered would fly into a passion, become destructive and greatly overwrought. This would soon pass away, but it was noticed as the child grew older she became worse, less susceptible to control, and developed sundry degenerate traits of character. From the father's statement, it seems that the girl reached the age of eighteen without very serious trouble, maintaining fair self-control with only an occasional mani- festation of viciousness. At the latter age, however, she had a serious outbreak and for several weeks lost entire control of her mischievous and perverse tendencies. This was followed by a somewhat tumultuous interval of four years, at the end of which she again had an outbreak extending over a like period of time. She threatened her parents with a knife, broke dishes and furniture, and was a menace to the family safety except when in the presence of her father. Through the earlier months of her residence in the hospital she was subject to paroxysms of fury and destructiveness, during which she was mischievous, vicious, and subject to great mental restlessness. During one of these she seized a bottle of camphor and chloral hniment from a nurse and drank a portion without subsequent injury. She repeated this rash act immediately afterwards, and regretted that she was unable to control her impulses. She remained excited and disturbed for four months, and then began to improve rapidly, becoming quiet, orderly, and finally manifesting few perverse tendencies. Second admission, constituting her fourth outbreak, was after an interval of three years. During this period she was turbulent and mischievous, but maintained fair control. Her second residence in the hospital was marked by a repetition of her former excesses. If anything, this last attack was marked by an increase in vicious and destructive tendencies, sometimes premeditated, while others had the appearance of being entirely impulsive. She would emphatically deny all of her behaviour which was unobserved but readily traceable to her as the ofiender. When discovered in any of her depredations, she acknowledged her guilt with profuse regrets, and promised to restrain herself in future, but, nevertheless, would take the first opportunity and from time to time attack slyly fellow-patients when nurses were not looking. One minute she would talk sociably and kindly with an associate, while the next, if unobserved, or if the converser's attention was dis- traught, she would strike a violent blow with anything which might be ready at hand to inflict injury. She seemed to appreciate the enormity of her offences, and regretted her lack of self-control. She was a confirmed kleptomaniac, and exhibited a high degree of secretiveness following upon her lapses. She was also a pyromaniac, having on one occasion set fire to her father's residence. It was observed that she had excessive bulging of the temporal bone on the right side, making the head prominently asymmetrical. Other Cases of Abnormal Development of Temporal Lobe. ARNOLD PICK (" Prager Mediz. Wochenschrift," 1879) : Patient was brought to the asylum strapped down on an ambulance by the police, he having become suddenly acutely maniacal, threatening to kill someone, i68 THE MENTAL FUNCTIONS OF THE BRAIN and could only be overcome by the combined strength of several men. On the following day patient was calm and perfectly normal. He gave his history correctly, and stated that he always got easily excited to acute anger, but that the anger as rapidly disappeared . The cause in this case arose within himself ; some reflections about past events made him angry, and his fury increased at the attempts of wife and friends to pacify him. On examination an. asymmetry of the head was noticed. The left temporal bone bulged so much that it formed a perfect groove at its j unction with the frontal and parietal bones. No other evidence of disease or other ab- normality could be found. H. VOPPEL (" Allg. Zeitschrift f. Psychiatrie," vol. xiv.), pubUshed several such cases. Cases of Hematoma Auris in Violent Mania. E. H. VAN DEUSEN (" American Journal of Insanity," 1874) : A young farmer of good constitution, age twenty-one, was seized with acute mania, persistent destructiveness of everything within reach and incessant motion. Five weeks after admission well-marked haematomata occurred in both ears, passing through the usual stages and terminating in the characteristic disfigurement. It was followed by an abatement of the excitement, convalescence was estabUshed, and he was discharged recovered. He continued in good health. MacDONALD {ibidem, 1887) : Patient, age eighteen, maniacal and violent. This was his second admission, w^hen he developed double haematomata, which increased rapidly and were appa- rently painless. In each case the swelling was confined to the concha, giving a very peculiar appearance. Absorption was rapid and at the end of a month the tumours had nearly disappeared, leaving the usual thickening. At the same time the mental disturbance had gradually subsided and convalescence was established. The patient was observed for the three years following his illness, he being a prisoner, and he kept perfectly well during that time. Other Cases of Htsmatoma Auris in Violent Mania with Recovery recorded by : TEATS, homicidal. British Medical Journal, 1881. FRED. NEEDHAM, ibidem, 1890. TISHKOFF, Lancet, 1892. CHATELIN and de MARTEL [op. cit.) have made no such observations as are cited ixi this chapter. As disciples of PIERRE MARIE, they deny even the existence of word-deafness in lesions of the temporal area ; " not a single case has been observed " by them, whereas about twenty cases have been quoted by me. They acknowledge, however, that the patient " often speaks too much " and that " he presents jargona- phasia," symptoms that are familiar to psychiatrists, being common in acute mania. The evidence I have quoted in this chapter is also of importance in showing the frequency of epilepsy in lesions of the temporal lobes. It should receive more than cursory attention by neurologists. Dr. RICHARD EAGER (see p. 121 and 145) had only three cases of serious injury in the temporal region. One of these sufiered from " maniacal excitement," as we should expect ; another is claimed by him as melancholic, but in reality complained only of pain in the head, and got well on " persuasion." The third seemed confused and wandered about aimlessly. There were three other cases of temporal injury, in the posterior region (described in next chapter under " Delusions of Persecution "), and one of these is mentioned as suffering from "an acute hallucinatory state and was for weeks in a state of acute maniacal excitement." CHAPTER XXXII OTHER PRIMARY MENTAL DISPOSITIONS AND THEIR CEREBRAL ORIGINS SUSPICION AND ITS CEREBRAL ORIGIN In Chapter XXVII. it has been shown that a feeling of suspicion is a necessary element of self-preservation. It varies in degree in different individuals. From the examples of brain lesions which will be quoted it would appear that the upper posterior part of the temporal lobes has some connection with it, i.e., a part of brain midway between the supra-marginal and angular convolutions of the parietal lobes — the centres of the emotion of fear — and the lower part of the temporal lobes — the centres of the irascible emotion ; consequently both these psychical tendencies may be involved. Morbid suspiciousness and delusions of persecution can arise, particularly in young people, from other causes than a limited brain lesion, as an exaggeration of a natural disposition to taciturnity and distrustfulness, to seek solitude, to sensitive- ness of character, and a hypochondriacal condition. Such people begin to interpret everything that happens in a bad sense and as intended to do them harm. They Suspect everybody and everything, and see hostility everywhere and are constantly on their guard, and the most trifling incidents acquire in their eyes an extra- ordinary importance. Sometimes they begin to imagine that everybody is looking at them or talks about them. All the words they hear the)^ refer to themselves. Gradually they suspect people of spying and listening at the door, and following them when going out. Their mistrust makes them exceedingly reserved. For a time they struggle against their delusions, recognising the possibility that they are such, but gradually their delusions assume a more systematised form ; then they accuse a certain person or persons, authorities or societies of conspiring against them, and for definite reasons, which they can make very plausible. They now think themselves important personages to be the object of so much hate, conspiracy, or other unpleasant attention on the part of their fellow-creatures. At this stage, or even before, actual hallucinations may set in, the principal one being that of hearing. Hallucinations of sight are extremely rare in these cases — the sight centre not being in the temporal lobe — but hallucinations of smell and taste are not uncommon, hence the idea of being poisoned. These hallucinations, it will be seen, can be explained on anatomical grounds ; for it will be shown that the lesion found in delusions of persecution is in the temporal lobe, so that the propinquity of the ear will account for the hallucinations of hearing, and, as will also be demonstrated, the gustatory centres are in the same vicinity, and are subject to the same Uability of morbid excitement. W. T. TIGGES (" Allg. Zeitschrift f. Psychiatric," 1888) has shown that in this form of insanity the weight of the frontal lobes is least diminished, next come the parietal lobes, and the temporal lobes suffer the greatest diminution. 170 THE MENTAL FUNCTIONS OF THE BRAIN Delusions of persecution may occur without any other signs of disease, and they may occur as complications in melancholia as well as in mania furiosa. The latter two are merely extensions of disease already existing, from the central parietal area in melancholia and from the inferior temporal area in mania furiosa to the posterior superior temporal region. It has been shown in the last chapter that epilepsy frequently involves the temporal lobes. Hence on the one hand the violence and homicidal tendency of many epileptics, and on the other the hallucinations of hearing and delusions of persecution. This observation was also made by PARANT (" Archives CUniques de Bordeaux," 1895). The proximity of the internal ear to this brain area accounts for hallucinations of hearing being so frequent in the delusions and mania of suspicion and persecution — they are generally of a threatening nature — and also explains why this same morbid mental state may arise when ear disease spreads to the temporal lobe. It is also a well-known fact that deaf people are particularly subject to ideas of suspicion and persecution. It has been observed by several authorities that chronic middle ear disease may produce a psychosis. Whether this connection is dependent on increased intra- cranial pressure, direct meningeal irritation, reflex nervous conditions, or disturbed cerebral circulation is not determined. But the fact remains that, in these cases, cure of the ear disease cures the psychosis, and if pus is formed and retained the mental defect is aggravated. Hence, whenever we get unreasonable suspicion or delusions of persecution, we should examine for ear disease and inquire for hallucina- tions of hearing. FISHER (" American Journal of Insanity," 1888) found only two exceptions in forty-seven cases of mania of persecution that came under his notice. BOUCHERON (" Gazette des Hopiteaux," 1887) observed mental troubles of suspicion and persecution to accompany ear disease. PIERRE I^IARIE did the same, and so did E. C. LASEGUE and C. FURSTNER. Increased pressure alone seems to suf&ce to set up delusions ; and the moment pus escapes from the ear the mental trouble disappears. This is an observation made by SCHULE, KOPPE, GRIESINGER, JACOBI, KORNER, HUGUENIN, MOREL, ROBIN. BENNETT, and IMacEWEN who have all reported similar cases. REDLICH and KAUFF- MANN found ninety per cent, of paranoia cases among patients suffering from ear trouble. W. S. BRYANT claims fifty per cent., but puts nearly the whole of the remaining cases under " dementia." Dean Swift suffered from middle ear disease, which gave rise to insane suspicion and irritability, and to this may be ascribed his cruelty to Stella. Case of Injury to Posterior Temporal Region with Delusions of Suspicion and Persecution By THE AUTHOR : A young South American had been sent to London for a change of scene, after he had fractured the mastoid process in a fall from his horse, and had become mentally unsound. At first he seemed able to exercise some control, but later, at the time of the consultation, he had secluded himself from all societ}^ and com- plained, amongst other suspicious ideas, chiefly of threatening persecutors. An operation was arranged, but before the day fixed upon he threw himself from a third- floor window and wae killed. RECOVERY AFTER SURGICAL OPERATION By THE AUTHOR : Patient had chronic ear disease from his childhood. He was mentally quite normal and an active business man until two years before, when in consequence of idccis of persecution he changed his occupation rather frequently and succeeded in OTHER PRIMARY MENTAL DISPOSITIONS 171 none. Getting worse, he refused to eat any food that had not been first tasted by others, and refused to speak with anyone except his nearest relatives, to whom he spoke quite rationally, thus showing that he was suffering from a disordered state of feeling, and not of the intellect. An examination was made of his ears. The disease in the right ear was healed, but there was necrosis of the left ear. When he was operated upon, the left temporal bone was found of ivory-like hardness, there was not a trace of mastoid cells, and the bone had to be chiselled through to get at the brain. The dura was thickened and was cut cross-like in two. The wound healed readily, and patient spoke to his attendants directly after the operation. He got perfectly well, and remained so. W. RHYS WILLIAMS (" Journal of Mental Science," 1879) : D. C, age twenty-six, had enjoyed good health, was industrious and sober until some days before admission, when he became excited, noisy and violent. He was continually swearing and screaming, said he saw devils, and was violent. Six months later it was noticed that he had a profuse purulent discharge from the left ear. He said he had this for months past. Slowly a large puffy swelling formed over the left mastoid process and spread up over squamous portion of temporal bone. On pressing this the discharge ran freely from the meatus. As a rule the patient was sullen and dangerous, and would not allow anyone to examine him. He fancied the doctors wanted to injure him. The following month, the abscess having got still bigger, it was opened, and he became sane at once. No further discharge took place from the ear. J. M. KOPPE (" Archiv f. Ohrenheilkunde," 1875) : Richter, a miner, sustained, when thirty-one years of age, a fracture of the base of the cranium, was eight days unconscious, and ill for three months. He became somewhat deaf, and there continued buzzing in the right ear. Two years after the accident he became mentally changed. He suffered from delusions of perse- cution : people robbed him of everything, intended to poison him, spoke badly of him. He threatened to kill his wife and children and to commit suicide after- wards. The otorrhoea got worse, and with it his delusions. On treating the ear- disease his mental derangement disappeared completely. E. REGIS ("Annales Medico-Psychologiques," 1882) : A young man, age twenty-two, received, when thirteen years old, such a severe box on the left ear that purulent middle ear disease resulted from it, which became chronic. Typhoid fever in his sixteenth year made the ear disease worse, and he became quite deaf in the left ear. Since then he had hallucinations of hearing of an insulting character : yet the patient was conscious of their origin, and had no delusions about them. Local treatment of the disease made the hallucinations disappear. B. BALL ("L'Encephale," 1882) : Similar case with cure. CHARLES PHELPS (" Traumatic Injuries of the Brain," 1898) : Male, age forty-five, thrown from a truck in a collision, unconscious. Third day ecchymosis over right mastoid process and extending upon the back of the ear. Irrational and required restraint, had delusions, saw imaginary persons, and heard scoffing voices, was easily annoyed when spoken to, considered it an outrage to find himself subjected to having his temperature taken. His mental faculties were completely restored after operation. W. SOHIER BRYANT ("Annals of Otology," St. Louis, 1905) describes four cases of persecutory mania with auditory hallucinations. All recovered after operative treatment. The same author (" Journal of Nervous and Mental Disease," 1906) has an article on " The Great Psychical Importance of Ear Disease." He again gives numerous examples of purulent inflammation of the middle ear followed by psychoses, which disappeared on treatment of the ear trouble. The following is an example : " The author has a case of a child, five years old, who has recurrent purulent inflammation of both tympani. If there is any retention of pus, maniacal attacks come on, during which the child makes inarticulate cries, breaks everything within reach and fights desperately with all the members of the family, including those it is most fond of at other times. These seizures are constant during the attack. 172 THE MENTAL FUNCTIONS OF THE BRAIN Attention to the middle ear conditions and drainage of the pus reUeves the cerebral irritation at once." EDWIN GOODALL (" Lancet," 1898) : Male patient, age twenty-nine, previously healthy, always temperate. No hereditary tendency. Six weeks before admission he received a kick from a horse on the left mastoid process, which rendered him unconscious. He bled from left ear. After coming round he developed marked delusions of suspicion, and exhibited violence, so that he had to be transferred to Hanwell Asylum. Considerable scar over left mastoid process. Complete left facial paralysis. After surgical treatment he became perfectly rational. Discharged three months later, and a month after discharge patient reported himself well and at work. DAMER HARRISON (" Journal of Mental Science," 1902) : A gentleman, age forty-six, who held an important Government appointment, and was admitted into Haydock Lodge Asylum in 1906. He had suffered for the past year from delusions of persecution of disparaging and threatening character. An operation was decided on in the region of the temporal lobe — auditor}^ centre — oa the left side. The brain bulged into the opening of the wound, and on incision into the dura mater a considerable quantit}^ of serum escaped. On the day after the operation the voices appeared to the patient more like a jumble of noises. On the fourth day he could still hear the voices at times, but he was peaceful and com- fortable. Instead of being wrapped up in his own misery, he watched what was going on in the room, was inclined to talk, and his manner was bright. On the fifth day the sounds became indistinct and were no longer heard as voices. On the twelfth day the noises too had disappeared, and on the twenty-fourth day he was discharged cured. He reported himself three months later free from relapse. E. AMBERG (" Journal of Nervous and Mental Disease," 1906) : Auditory hallucinations and persecutory mania. Recovery after treatment of ear affection. G. BURCKHARDT (" AUg. Zeitschrift f. Psychiatric," 1891) : I^Irs. B., married, healthy up to thirty-fourth year, then became melancholic, suicidal, developed delusions of persecution, and became dangerous to those around her. For sixteen years she remained in this condition in the asylum. Dr. Burck- hardt removed a strip of the parietal lobe (gyrus angularis and supra-marginalis — seat of melancholia, see preceding chapter) and a strip of the posterior part of first and second right temporal convolutions (also part of Broca's convolution without influencing her speech). He claims that patient lost her desire for attacks and abuse and her delusions, and instead of the depressed condition she became lively and communicative. The SAME AUTHOR {ibidem) : This subject was a man, age thirty-five, who had been four years in the asylum. He was suspicious, had fear of being poisoned, became threatening, heard voices, and was violent and destructive. Dr. Burckhardt trephined for the auditory centres above left ear, and removed about 28 grammes of brain substance. The brain was found of a slate colour. The patient did not become wovd-deaf after this operation, but the hallucinations became less intense and the mental condition improved. He was now perfectlv quiet, and took an interest in things. The SAME AUTHOR [ibidem) : M. M., artist, delusions of persecution with hallucinations of hearing which caused irascibility'. Auditory area excited, weight of brain removed 4-6 grammes. Patient lost his irascibility. Dr. Burckliardt in a second operation removed another strip, when the patient's mind cleared up. He began to draw again, could play a game of cards and billiards correctly, became polite and obedient. HENRY MAUDSLEY ("Lessons of Materialism," 1879) : " Some years ago a miner was sent to the Ayrshire District Asylum who, four years before, had been struck to the ground insensible by a mass of falling coal which fractured his skull. He lay unconscious for four days after the accident, then came gradually to himself, and was able in four weeks to resume his work in the pit. But his wife noticed a steadily increasing change for the worse in his character and habits ; whereas he had formerly been cheerful, sociable and good-natured, always kind and affectionate to her and his children, he now became irritable, moody, surly, OTHER PRIMARY MENTAL DISPOSITIONS 173 suspicious, shunning the company of his fellow-workmen, and impatient with her ahd the children. This bad state increased ; he was often excited, used threats of violence to his wife and others, finally became quite maniacal, attempted to kill them, had a succession of epileptic fits, and was sent to the asylum as a dangerous lunatic. There he showed himself extremely suspicious and surly, entertained a fixed delusion that he was the victim of a conspiracy on the part of his wife and others, and displayed bitter and resentful feelings. At the place where the skull had been fractured there was a well-marked depression of bone, and the depressed portion was eventually removed by the trephine. From that time an improvement took place in his disposition, his old self coming gradually back ; he became cheerful again, active and obliging, regained and displayed all his former affection for his wife and children, and was at last discharged recovered." TEMPORAL INJURY WITH DELUSIONS OF PERSECUTION Case of Recovery. THOMAS DRAPES (" Journal of Mental Science," 1904) : Patient, age thirty-six, employed at office work, most temperate all his life, always healthy and athletic, an enthusiast about games. Many years ago, when playing football, he got a kick on the left side of his head, just over his ear, and some six months after he began to suffer from deafness, v/hich he attributed to the injury. An eminent London aurist, however, did not attach much importance to this, and seemed to regard the deafness as due to Eustachian obstruction. For a number of years he had some discharge from the ears. He had a slight blow again on the top of the head by a hockey stick, and from that day he was very fidgety and restless, except when under the influence of sleeping draughts. One night, the month following, he sprang over the foot of the bed, imagining he saw men coming in at the door. Another day he saw two men, one in the wardrobe, the other standing opposite the side window, of which the shutters were shut. He seized liis hot water jar and flung it with all his force at the latter, as he thought, and it went within a few inches of his sister's head, who was sitting at the fire with her back to him. Had he aimed at the man in the wardrobe, he must have hit her and might have killed her. All this time his hearing was much more acute than normal. He made slow recovery, and as he goL better the deafness gradually returned. He wrote afterwards a long account of his delusions, which were connected with a conspiracy. . Medico-Legal Case of Temporal Injury followed by Homicidal Tendencies. JULIUS KRATTER (" Friedreich's Blatter f. Ger. Medizin," 1889) : Josef H., while walking with some companions, had, as afterwards was shown, a momentary delusion of persecution, and this delusion incited him to knock one of his friends down, and, when attacked by the other, he stabbed him several times, apparently in self-defence. On arrival home he boasted of his intention to murder thirty persons, and became very noisy and threatening. Numerous witnesses declared H. to be a violent, threatening and dangerous man, and that the change of his character dated from the receipt of an injury to his head. One medical witness declared him to be simulating ; another described him as intellectually very clear-headed, definite in his statements, adhering to them under cross-examination, having a good memory of facts and events, and never contradicting himself. He stated that twenty years before he was run over, and received a severe wound which caused him to be paralysed and speechless for a few weeks, and altogether indisposed for a whole month. A brother of his stated that since that time defen- dant had been intolerant of alcohol. Defendant remembered every detail of the act he was accused of, but stated definitely that his two companions intended to kill him. Questioned further, he said he was not mad ; he heard them distinctly arranging the plot ; he knew what he was doing, and was not going to let himself be murdered without some self-defence. It was then ascertained that defendant construed some remarks made by his companions in this sense, and when he walked faster to escape them they also followed him more quickly, whereupon he turned 174 THE MENTAL FUNCTIONS OF THE BRAIN round and fought, with the result given above. In reply to inquiries by the medical experts, he admitted having other enemies in the village, and gave their names and their intentions. Asked why he did not prosecute his enemies, he admitted that he applied for a summons against one of them, but the magistrate would not grant the summons. He believed the magistrate had been bribed. The physical examina- tion revealed the following anomalies : facial paralysis and paresis of sympathicus on right side ; over the ear at the junction of the right temporal with the parietal bone there was a depression, the size of a five-shilling piece, holding three fingers easily. Superficial tissues were adherent. Scar not tender but sometimes painful. Right pupil larger than left. Opinion of experts that defendant had suffered for many years from delusions of persecution ; that these delusions dated from the injury, and had increased when hallucinations of hearing appeared. Moreover, he construed everything that might be said or done in the sense of his delusion. Since the injury he had grown very irascible. In his anger he often spoke nonsense, and the laughter and remarks caused thereby by those around him only increased his irascibility and delusion. Simulation was declared to be out of the question. In a postscript Dr. Kratter stated that the Court handed the prisoner to the mayor of the district to deal with him as he thought proper. The mayor intended to send him to a lunatic asylum at once, but a superior authority intervened, so that H. was left at large. He immediately resumed his threats and violent behaviour, and to such an extent that the local people had to petition the Government to place H. in an asylum, since he was a public danger. Dr. Kratter added a special certificate. Only then was H. secured. Another Medico-Legal Case. W. FRANKEL ("AUg. Zeitschrift f. Psychiatric," 1869) : S. A., a very conscientious woman, age twenty-nine and a half, whose house was burnt, including all her property, which was not insured, interpreted some remarks by the neighbours as meaning that her husband had caused the fire. Fearing his arrest, she got into a state of terror, and left quietly, with her two children, the scene of her misfortune. An hour afterwards her cries were heard from a pond in the neighbourhood, where she had drowned her children and made an unsuccessful attempt to take her own hfe in the same way. She was arrested. At the trial she remained reticent, but betrayed in every feature and look her extreme anxiety, and gave the j udge the impression that she felt her guilt so much that she was afraid to betray herself if she spoke. Expert evidence showed that her silence, refusal of food, sleeplessness, fever, etc., indicated some mental derangement. She was sent to the psychiatrical chnic for further observation. She was found much depressed, but this condition had begun long before the fire. She was hereditarily tainted. On her head in the region of the left parietal bone some ulceration was observed. Her fever increased, and with it her fear of death. She asked for a priest, and confessed to him that she herself laid the fire to get away from the town, which she abhorred, and gave details of the preparations she had made to fix the suspicion on others, which confession left the impression on the judge, to whom she repeated it, that she had told the truth and was not under a delusion. She died of pyaemia. Post mortem, there was a necrosis of the left parietal bone with loose pieces, the parietal lobe being covered with pus, which had made its way to the temporal area and middle fossa. Dr. Frankel thought the necrosils was the result of an injury. Another Medico-Legal Case. A. KOHLER (" AUg. Zeitschrift f, Psjxhiatrie," 1877) : A woman, age forty-seveci, a habitual thief with long records of imprisonment, whose trials were always interesting by reason of the craftiness with which she planted her guilt on others, became quarrelsome and violent in manner. Four weeks after being discharged she committed another theft, and received one year of hard labour for it. But this time her mental state received notice, and she was sent to an asylum. Her violence was accounted for by horrible delusions erf persecution with hallucinations of the same kind ; she saw only enemies, detected poison everywhere ; but, unhke a melanchohc, who would simply refuse to eat, she destroyed the plates OTHER PRIMARY MENTAL DISPOSITIONS 175 and dishes, and behaved altogether outrageously. She remained in this condition for years. Gradually paralysis set in. She died of phthisis. Post mortem, there was softening of the temporal lobe. Other Cases of Temporal Lesions with Delusions of Suspicion and Persecution CONOLLY NORMAN ("Journal of Mental Science," 1894) : Patient, age forty-two, entertained fixed persecutory delusions, chiefly to the effect that people in the jail had put beasts in his inside to torture him ; that his chest was full of gnawing beasts, and so forth. He complained bitterly of his treatment, and said that the asylum authorities were conspiring with the prison warders to persecute him. No hallucinations. Post mortem, porencephaly was found involving the greater part of the left temporo-sphenoidal lobe and supra- marginal gyrus, holding sixteen ounces of perfectly clear fluid. The left parietal eminence and left parietal cortex were distinctly more prominent than the right. ALBERT ROSENTHAL (" Centralblatt f. Nervenheilkunde," 1884) : Patient, age twenty-five, with ear disease, which in three months' time left him deaf. Simultaneously therewith mental derangement took place, the patient having delusions of persecution and attacks of maniacal fury. To escape from his per- secutors he made an attempt to jump down from a fourth-floor window. The excitement never abated. Epileptic convulsions followed in such rapid succession that he was dead in a few hours. Post mortem, there was a focus of yellow softening in the right temporal lobe extending to the external capsule. PAUL SCHULLER (" Psychosen nach Kopfverletzungen," Leipsic, 1882) : F. B., age sixteen and a half, an apprentice, with ear disease from his earliest youth, received in a fight a blow with a piece of wood which broke into pieces. It hit kim at the posterior junction of the right temporal and parietal bones, leaving a scar. He became insane, sufiering fro-m delusions of persecution. He was in fear of being hacked to pieces and of being poisoned ; he was suspicious of everybody and everything, and to defend himself became extremely noisy, violent, and made attempts at homicide. J. T. ESKRIDGE ("Journal of Nervous and Mental Disease," 1889) : J. P., male, age thirty, Colorado ranchman, was left after typhoid fever with a purulent discharge from the right ear. During the following fortnight he was observed to be getting irritable, and one day was found in bed delirious, and with the delusion that his attendants were trying to kill him. His eyes followed the physicians and people in the room, as if suspicious of the actions of those by whom he was surrounded. He accused his attendants and Dr. Eskridge of seeking an opportunity to kill him, and cursed them accordingly in the unpolished language of a Western ranchman. The doctor received profane abuse for every question that he put to him. There was a sanious or serai-purulent discharge from the right ear, slight in amount but offensive in character. His appearance was depressed and anxious. His left arm and muscles of left angle of mouth were paretic. He was trephined and a large abscess cavity emptied ; but the patient's improvement was only of short duration, and he died on the fifth day. Post mortem, there was found, besides this cavity, pus on the petrous portion of the right temporal bone with meningeal inflammation around. JOHN KEAY (" Journal of Mental Science," 1894) : Patient, age fifty, was sufiering from monomania of suspicion of about a year's duration. He had auditory hallucinations. Mentally he was an excitable, irritable monomaniac, full of delusions of suspicion. He charged people with hatching plots to do him injury, was extremely hot-tempered, and answered the most civil remark with a torrent of abuse and threats of civil action or physical violence. Thus he continued for four months, when his hitherto robust health declined, his appetite failed, and his weight diminished. It was then observed that he frequently placed his hand on the right temporal region, and at the same time it was noticed that there was a slight purulent discharge from the right ear, in which he seemed deaf. Patient resisted all personal examination. A month later he had fever and became semi-comatose. There was a swelling with tenderness on pressure over the mastoid 176 THE MENTAL FUNCTIONS OF THE BRAIN bone. It was agreed that the case was one of basal meningitis, arising from the purulent otitis media. The skull was trephined half an inch posterior to the external auditory meatus, and the pus allowed to discharge. Improvement seemed to follow the operation, but the patient died the following day. Post mortem, the convolutions of the teraporo-sphenoidal lobe on the right side were softened. The walls of the ventricles were also soft, and they contained a quantity of semi-purulent fluid. CHARLES W. BURR ("Journal of American Medical Association," 1907) : Case 15 : A negro, ago thirty, sustained a depressed fracture behind the left ear from a blow from a baseball bat, for which he was trephined on account of pressure symptoms. After the operation he became partially word-deaf and at the same time had auditory and visual hallucinations. He soon became unmanageable, and was violent and abusive. He had delusions of persecution. The brain showed distinct injur^^ to the auditory speech centre. TEMPORAL TUMOURS WITH DELUSIONS OF PERSECUTION Tumour of Temporal Lobe found in a Murderer. W. C. SULLIVAN, then Medical Officer, Holloway Prison, now one of H.M. Prison Commissioners ("Lancet," 1911) : Case of Dr. R. Cunyngham Brown, of H.M. Convict Prison, Parkhurst : " The patient, who was stated by the police to be a heavy drinker, murdered his wife ; while awaiting trial he complained of visual and auditory hallucinations, and developed a persecutory delirium ; after a period of remission the persecutory symptoms recurred with increasing mental confusion and apathy, and the patient died some seventeen months after the crime. At the post-mortem examination a large tumour was found infiltrating the right temporo-sphenoidal lobe." Dr. Sullivan continued : " So far as I am aware, this is the only case on record of actual homicide in this disease." Numerous cases of temporal tumours with homicidal tendencies have been given in this and the previous chapter, and here are some more. Other Cases of Temporal Tumours with Delusions of Persecution and Homicidal Tendencies. F. J. MANN and J. O. STRACHAN, State Hospitals' Bulletin, 1891. R. M. MARSHALL, Journal of Mental Science, 1909. HARTMANN, Archiv /. Psychiatric, 1884. HENRI. p. DAGONET, Annates Medico-Psychologiques, 1882. H. SCHULE, Sectionsevgehnisse hei Geisteskranken, Leipsic, 1874. INFLAMMATION OF TEMPORAL LOBE WITH DELUSIONS OF PERSECUTION Examples of other Temporal Lesions with Delusions of Suspicion and Persecution. TOMASCHEWSKY and SIMONOWITSCH (" Wjestnik Psichiatrii i Nevro- patologii," 1888) : Patient, age thirty-three, always of good health, was frequently struck on the head by a drunken husband. She had subsequently several attacks of general convulsions which continued till her death. On admission, the principal symptoms were excitement, sleeplessness, delusions of persecution, and hallucinations of hearing. She heard with both ears the voices of her tormentors. There was chronic catarrh of the left Eustachian tube. Post mortem, there was thickening, adhesion, and injection of the dura over the gyri supra-marginalis and angularis and posterior half of first temporal convolution, and the brain substance of these parts appeared injected and wasted. CH. VALLON ("L'Encephale," 1881) : Patient, age thirty-five, had delusions of persecution. Four months later he had hsematoma of right ear. He died a fortnight later of pneumonia. Post mortem, there were sanguinary effusions of both right and left temporal lobes in the posterior parts. OTHER PRIMARY MENTAL DISPOSITIONS 177 T. DUNCAN GREENLEES ("American Journal of Insanity," 1887) : James K., age fifty-three, had been insane for eighteen months previous to admission, consequent upon a paralytic seizure, the effects of which had partly disappeared. On admission he had a suspicious look, was very restless, and had the fixed delusion that persons wished to poison him. During his residence he was passionate, and became easily excited. If left to himself he was dull, and would speak to no one, preferring the solitude of his own company. Eighteen months after admission he had another paralytic seizure, accompanied by aphasia. Death nine days later. Post mortem, the whole of the left temporo-sphenoidal lobe was in a state of red softening, and broken down into a cavity. Part of the adjacent lower parietal lobe was also involved. WM. JULIUS MICKLE ("Journal of Mental Science," 1883) : A soldier, age thirty-five, eighteen years' service, temperate and of good conduct. Ten years previously he was struck on the parietal bone, scar still visible. Six years later he became mentally changed : depressed, discontented, making silly and unfounded charges against those around him. He had absurd delusions of ill- treatment, of being starved, of having daily frightful corporeal injuries inflicted, of his life being threatened, and attempts being made to poison him. Right mastoid process was tender to the touch. C. PRICE TANNER (" Brain," 1890) : T. R., age thirty-three, married, telegraph clerk. The history obtained from his wife was to the effect that he had always enjoyed good health, and had had no illness till twelve months before admission. At that time he suffered from " writers' cramp " and was low-spirited. After a holiday he recovered. A month prior to admission he was found with right hemiplegia, unconscious for four days. Paralysis improved, but his speech remained unintelligible. After a fortnight, when he got up from bed, his moral character was found changed. From being a fond father he seemed to take an aversion to his children, and was found by his wife more than once ill-using them. On one occasion he was holding one of them on the floor, kneeling over her with a knife in his hand. He became also very suspicious, and since his attack had slept with a hammer and knife by his bedside. He had also lately extra locks and bolts put on his doors. In consequence of his threatening behaviour to his wife and children it was found necessary to put him under restraint. He suffered from word-deafness and word-blindness. He died three months after admission. Post mortem, the whole of the left insula was found destroyed, ap- parently the result of haemorrhage, and the haemorrhage had invaded the superior part of the temporal lobe, extending right across to the inferior parietal lobule. H. SCHULE (" Sectionsergebnisse bei Geisteskranken," Leipsic, 1874) : Hy., age thirty-nine, first suffered from indecision and irritability, later became bad-tempered and more irascible. He had several apoplectic strokes, which passed off, and after which his irascibility became permanent. In his paroxysms of excitement he expressed delusions of persecution, tried to run away, shut himself up in other people's rooms to escape from his persecutors, who Avere going to kill him. He offered active resistance to those who came near him. Emotionally he was m a depressed condition ever since the commencement of his illness. Patient died of pneumonia after four years' illness. Post mortem, dura was found adherent to the posterior portion of the temporal bone. The right temporal lobe was much atrophied, so was the left at the base. On section, a cavity three-quarters of an inch in diameter was found in the left temporal lobe. Large osteophites in the middle fossa. Right parietal eminence more prominent than the left, and con- taining also more brain substance. Sir GEORGE H. SAVAGE (" Brain," 1878) : Sarah N. N., age thirty-five, aunt and cousin insane, father died of " brain softening." About five years prior to admission she had a love disappointment, and since then on several occasions she had short attacks of mental excitement, but these rapidly passed off. A few days before admission she became rather suddenly noisy and violent. Fancied people had knives concealed and meant to murder her. She said " her bed was an infernal machine," and that she was " surrounded by devils." She had wonderful visions, talked incoherently, and was very violent. She had hemiplegia a month after admission and died a week after of pneumonia. Vol. ii.] H 178 THE MENTAL FUNCTIONS OF THE BRAIN Post mortem, it was found that the right temporal lobe was flat and bulging, and on incision an ounce of thick pus escaped, disclosing a thick-walled abscess occupying the whole of this part of the brain. Rest of the brain apparently normal. T. C. SHAW (" Archives of Medicine," New York, 1882) : M. R., age thirty-four, married, four children, had a sudden attack of loss of consciousness, lasting two weeks, since when she was insane. The certificate committing her stated that she said some men were trying to kill her, and she screamed without cause, and was at times violent. A month after admission she had a severe epileptiform fit, after which she continued noisy, screaming un- intelligibly night and day. Post mortem was found atrophy of superior temporo- sphenoidaJ convolution extending to parietal lobe in both hemispheres. CHARLES K. MILLS and WILLIAM G. SPILLER (" Journal of Nervous and Mental Disease," 1907) : Case of delusions of persecution, after fracture of the base of the skull — in which was found post mortem contusion of the posterior part of the first and second temporal convolutions. Other Examples : F. JOLLY, bullet wound. Archiv f. Psychiatric, 1872. R. v. KRAFFT-EBING, bullet wound, tjber die durch Gehirnersch. u. Kopfverl. hervorger. psych. Krankheiten, 1868. K. CRAMMER, Archiv f. Psychiatric, vol. xxi. L. SCHLAGER, Zeitschr. Gas. d. Aerzte z. Wien, vol. xiii. LANDERER and LUTZ, two cases, Christophshad Asylum Report, 1878. P. DEECKE, American Journal of Insanity, 1883. G. C. GABLETT, ibidem, 1877. J. B. M. PARCHAPPE, Traite de la Folic. D. M. B. BOURNEVILLE, Archives de Neurologic, 1880. F. BAIZER, Gazette Medicate de Paris, 1884. W. C. HOOD, Journal of Psychological Medicine, vol. xi. EDWIN W. DAY, Annals of Otology, 1911. W. FRANKEL, Allg. Zeitschrift f. Psychiatric, 1869. G. HEBOLD, ibidem, 1894. HUNGER AND THIRST AND THEIR CEREBRAL ORIGIN The most elementary instinctive impulse of animal nature is the impulse to satisfy hunger and thirst. The substrata of the appetite for food and drink are the stomachic branches of the vagus nerves and their cerebral centres ; and as local conditions of the stomach may destroy or increase the feeling of hunger and thirst, so central disease may give rise to ravenous appetite, sitophobia, conditions ex- emplified in certain forms of insanity. It is objected that hunger, or the desire for food, is referable exclusively to the state of the stomach. Facts, however, are against the objection. A certain condition of the stomach gives rise, no doubt, to the sensation of hunger, just as a certain condition of the eye does to that of light ; but the sensation itself takes place in both instances in the brain. If we never experienced a desire to eat or drink except when the stomach required food or liquid, intemperance and disease would play a much smaller part in the drama of life than they actually do. If the stomach were the sole seat of appetite we should never witness the apparent anomaly of excellent digestion existing without any desire for food, or great craving without the power of digestion. Hunger and thirst are commonly given in physiological text- books as marked and typical examples of " general sensibility." On the other hand, impulses to satisfy hunger and thirst have always been set down as instinctive. Now, the feel- ings of hunger and thirst themselves prompt to the same sort of conduct as these so- called instinctive impulses. Indeed, it seems possible that the same inner core of OTHER PRIMARY MENTAL DISPOSITIONS 179 the psychic happenings, which in the one case is regarded as a visceral feeling, may- be identical with that which, in the other, is named an instinct. What, then, should result if, instead of conceiving the inner core of the feehngs of hunger and thirst to be the counterparts of certain visceral currents running to the brain, we were to turn squarely atiout and regard them as motor ideas seated congenitally in the brain, and let loose from it to prompt the creature to specific action for procuring sustenance ? Unquestionably our attitude of investigation of such matters would be revolutionised, and a wider horizon would be given to the problem. We should now expect these instincts to be aroused in more than one way — by smell, by sight, and even by sound, as w^ell as by a condition of the stomach. Moreover, since in cases of instinctive impulses aroused through vision, for example, of an animal at sight of its prey, we should think it ridiculous to seek an explanation of these instincts wholly in the eye, so we should now be led, maybe, to recognise how faulty it has been for physiologists to seek an explanation of hunger and thirst wholly within the viscera. Of course, the mere taking of this vsdder view would not, of itself, solve all the mysteries of hunger, nor illumine beyond shadow all the realms of physiology, of insanity, and of emotion. But it would bring light into all these regions. It would enable us to understand how herbivora and other animals, whose stomachs are commonly more or less full, should yet feel hungry at the sight of food. It would enable us to imagine at least how hunger, proceeding from an empty stomach, may be explained in different wajrs, and yet in conformity with the conclusion that the viscera afiord no direct sensory currents save of pain from pain- nerves and of muscle sense from muscular contractions. It may be that the mere emptiness of the stomach, or, again, the undue presence of its juices, incite muscular and peristaltic disturbances of such persistency or strength that they force their way to the cerebral centre, and thence arouse by association the proper instinctive feelings of hunger. Or in place of muscle sense, it may be that obscure and feeble pains are commonly the only direct visceral sensations, and these rising by pain nerves (sjnnpathetic) to the cortical centre. Again, all these things may be brought into hne with the fact that long-continued hunger may be lessened and apparently satisfied by the injection of food into the bowels. It is a small matter how hunger be explained — whether as visceral sensation or as instinctive motive — but the collateral issues are momentous. In the instincts of hunger and thirst animals eat and drink before they can know that food and drink induce that pleasant external sensation which constitutes the satisfaction of the instinct. But if the animals become conscious of the objects of the instinct the vohtional element is added, and the blind impulse of nature co- operates with the inclination of the animal to obtain it. The bhnd instinct is become the vohtional instinct for food and drink. In the pregnant, chlorotic, and hysterical female there is a desire for strange substances, and amongst the ordinary occupants of lunatic asylums we find some- times morbid desires, longings, or impulses for various substances generally regarded with loathing and disgust. In the condition called bulimia, the patient has an irresistible longing for food of a normal kind, so that an exaggerated form of gluttony results. This may occur first when the stomach is enlarged, and, secondly, when it is of a normal size. Under either condition the person devours an enormous quantity at each meal — as much, indeed, as would suffice for three or four ordinary men, and yet he may be haggard and gaunt in the extreme. Amongst the insane bulimia is common — some, having devoured their own antple allowance, seize all they can lay hands on, prowhng about the entire day in search of food. Another condition, called dipsomania, signifies a disordered cerebral condition, in which the individual madly drinks to excess, yet may loathe the degrading stimulant. On the other hand, the desire for food may be distinctly lowered in intensity or even lost. This is called anorexia. l8o THE MENTAL FUNCTIONS OF THE BRAIN Dr. HOPPE, of Copenhagen, was the first to observe a gustatory centre and centre for the alimentive instinct in the brain. In 1823 ("Edinburgh Phrenological Journal," vol, x.) he expressed the opinion that, besides the nerves of the stomach and palate, of which alone he conceived the sensations of hunger and thirst to be afiections, there must be also a centre in the brain of animals for the instinct of nutrition for the preservation of life, which incites to the sensual enjoyments of the palate, and the activity of which is independent of hunger and thirst. In a second communication, in 1824, he gave the results of numerous observations, locating th* centre of taste at the anterior extremity of the temporal lobe. Dr. CROOK, of London, claimed that several years before the pubUcation of Dr. Hoppe's papers, he himself had arrived at similar conclusions with regard to this propensity and the position of its centre. FERRIER has located the gustatory centre at the anterior tip of the temporal lobe, in close relation to the olfactory centre. He sa}^ : " It was noted in connection with electrical irritation of the lower extremity of the temporo-sphenoidal convolution in the monkey, and of the same region in the brain of the cat, that movements of the hps, tongue, cheek-pouches, and jaws were occasionally induced — phenomena which might be regarded as indications of the excitation of gustatory sensation. This interpretation receives support from the results of destructive lesions, and we have therefore reasonable ground for concluding that the gustatory centres are situated at the lower extremity of the temporo- sphenoidal lobes, in close relation with those of smell." (" The Functions of the Brain," London, 1876.) Mr. STEPHEN PAGET read a paper some twenty years ago " On Cases of Vor- acious Hunger and Thirst from Injury or Disease of the Brain," pubhshed in the "Transactions of the Clinical Society " of London, 1897, in which he quoted some ten cases, the lesion being in all at the anterior extremity of the temporo-sphenoidal lobe. Voracious appetite or bulimia, according to this theory, should be due to irritation of a certain part — the anterior tip — of the temporal lobe. If so, we should expect to see a manifestation of it in the two derangements we have already described as being due to lesions of the temporal lobe, namely (i) in acute mania, and (2) in epilepsy. This is actually the case. Of the former, several cases have already been quoted, and some more will be given ; and with reference to the latter, we may refer to Fere's paper on " La Faim-Valle Epileptique " (" Revue de Medecine," 1899). Extraordinary Case of Voracious Appetite. PERCY and LAURENT (" Dictionnaire des Sciences Medicales," article " Homophage ") cite the case of a Frenchman, named Tarrare, who when a lad would eat all sorts of odd substances to satisfy his ravenous hunger, with the result that he was frequently seized with colic. No sooner relieved than he resumed his previous practice. At the age of seventeen, when he weighed one hundred pounds, he would consume twenty-five pounds of beef daily. When in the army he would often devour his comrades' rations besides his own. When they guarded them- selves, Tarrare was nearly famished, and had to go to the hospital. There they had to grant him a quadruple allowance, and yet he ate the refuse of the kitchen as well, and sometimes would swallow the poultices and anything else that came in his way. He w^as reported to have eaten dogs and cats, and once to have eaten the dinner of fifteen labourers. He was utilised by the officers of his regiment for comical adventures, but gradually the novelty wore ofi. He lived a little while on what food he could steal from poultry-yards and elsewhere, but in the end returned to the hospital. There he was discovered to have eaten the flesh of dead bodies, and when once the dead body of a little girl had mysteriously disappeared he was OTHER PRIMARY MENTAL DISPOSITIONS i8i suspected of it and dismissed from the hospital. He turned up again at the hospital of Versailles, where he died shortly afterwards of purulent diarrhoea, at the age of twenty-six. Another Case of Voracious Appetite. (" Annalesde la Medecine Physiologique," 1832) : A woman of the name of Denise furnished a curious example of insatiable ap- petite for food. In infancy she exhausted the milk of all her nurses, and ate four times more than other children of the same age. At school she devoured the bread of all the other scholars. And in the Salpetriere Hospital it was found impossible to satisfy her habitual appetite with less than eight or ten pounds of bread daily. Nevertheless, she there experienced, two or three times a month, violent attacks of hunger, during which she devoured twenty-four pounds of bread. If, during her fits, any obstacle was opposed to the gratification of her imperious desire, she became so furious that she used to bite her clothes, and even her hands, and did not recover her reason till hunger was completely satisfied. On one occasion she drank the soup prepared for twenty persons and ate twelve pounds of bread. On another occasion she drank all the coftee prepared for seventy-five of her companions in the Sal- petriere. Post mortem, the anterior part of both temporal lobes were found abnormally developed. Yet Another Case of Voracious Appetite. J. B. F. DESCURET (" Lancet," 1836) : Patient, a woman, when at the Salpetriere, ate the allowance of from fifteen to eighteen persons a day. When turned out of the hospital she seized every possible occasion for stealing bread and other food. At last she was compelled to retire into the country without resource, and there devoured every species of vegetable food which presented itself within her reach. But deprived of the faculty which herbivorous animals possess of distinguishing wholesome plants, she gorged injurious vegetable substances, and at last died from the efiects of violent gastritis. The anterior tips of the temporo-sphenoidal lobes were found remarkably developed. Voracious Appetite following Injury to Temporal Lobes (" Archives Generales de Medecine," i86o) : A man fell from a high scaffold, and was removed to hospital. He had a con- tused wound of the temple and haemorrhage from the left ear. When he recovered consciousness after five days he was agitated, and constantly asked for food and drink. He drank daily from seven to twelve pints. He would call at the top of his voice for food and drink, and on one occasion he drank twenty-four and a half pints in one day. After some weeks his thirst slowly abated, and he left the hospital, in good health, eight weeks after admission. Another Case of Injury with Intense Thirst. BAUDIN (" Revue Generales de Medecine," i860) : A young man, age eighteen, working in a saw-mill, was struck with a piece of wood on the right temple, and was unconscious for some hours ; then came violent headache, fever, shivering, and intense thirst. Two days later he was well enough to go back to work, but his thirst persisted, and three weeks later he came to the hospital, begging to get relief from it. He was in good general health, his appetite for solid food was not excessive, he complained of nothing but extreme thirst, drinking all day, and waking at night again and again to drink. On one occasion in twenty-four hours he drank no less than fifty-two and a half pints. His urine was almost pure water, and did not contain any trace of sugar. He was treated with large doses of valerian, and in three weeks his thirst had much abated, and was daily getting less. Other Cases of Injury. PUTAWSKI (" Lancet," 1890) : A young man fell out of a waggon and struck his head against a stone. He was i82 THE MENTAL FUNCTIONS OF THE BRAIN admitted to hospital, unconscious, and bleeding from left ear. The diagnosis was fracture of petrous portion of temporal bone. On the fifth day he regained con- sciousness, and at the same time became inordinately hungry. The usual diet wholly failed to satisfy him. He constantly complained of hunger, and even cried for food. Six pounds of bread daily, besides other articles of diet, were not enough for him. The bowels acted regularly. There was no excessive thirst. After ten weeks his appetite fell to normal. HERMANN NOTHNAGEL (" Virchow's Archiv," 1887) : A man, age thirty-three, in consequence of a kick by a horse, fell and came down with his right ear against a piece of wood. He was stunned, and unable to rise. Half an hour later he felt great thirst, and drank more than five pints iu the next three hours, before admission to hospital. He was still suffering from thirst a fortnight after the accident, when he left the hospital at his own request. Within three hours of the accident he drank five pints of fluid, next day twenty-one and a half pints, the day after thirty-two and a half pints, the seventh day twenty-eight pints, on the eleventh day thirty and a half pints. A few days later, when he left hospital, his average had fallen to nine pints. There was no dryness of the mouth or throat, and the skin acted freely. The urine was clear, acid, free from sugar and albumen. W. H. BENNETT (" Clinical Society Transactions," London, 1897) : A man, twenty-two years old, was struck with a hockey stick on the left temple, and was unconscious for about a quarter of an hour. About a month after the injury he began to have a voracious appetite for solid food. He would eat a whole chicken at one meal, and on one occasion ate twelve large slices of meat for lunch, besides vegetables, sweets, etc. He had no excess of thirst. This abnormal hunger lasted over a year, and the appetite had not yet quite become normal at the date of report. Case of Temporal Abscess with Voracious Appetite. STEPHEN PAGET (" Clinical Society's Transactions," London. 1897) : Case of a boy, twelve years old, with an abscess in the left temporo-sphenoidal region. The patient was twice trephined. Three days after the first operation the notes say : " His appetite is remarkable ; he begs for solid food, and says, ' I want to go home ; they don't give me enough to eat here.' " Two days later the notes say, " Restless and noisy, appetite ravenous." At this time he had partial aphasia. He slowly recovered. Even when he was at his worst — delirious, lying in a state of stupor, or screaming wildly — he would eat and diiak greedily, taking more food than any man in the ward, asking for more, and saying, " What's the good of that • to me ? " Case of Temporal Softening with Insatiable Thirst. WERNICKE and FRIEDLANDER T' Fortschritte der Medizin," 1883) : Patient was deaf, had epileptic convulsions, and suffered with thirst so ex- cessively that she drank water by the bucket. Post mortem, there was gummatous softening of both temporo-sphenoidal lobes. Other Cases of Temporal Tumours with Voracious Appetite. N. FRIEDREICH, On Intra-Cranial Tumours, 1853. CRICHTON-BROWNE, British Medical Journal, 1873. S. W. D. WILLIAMS, Journal of Mental Science, 1869. Other Examples of Temporal Lesions with Voracious Appetite. E. F. BRODIE, bullet wound. American Practitioner, 1880. H. SCHULE, Sectionsergebnisse bei Geisteskranken, 1874. R. V. KRAFFT-EBING, Uber die durch Gehirnerschiitterung und Kopfverl. hervorger. psych. Krankheiten, 1868. LANDERER and LUTZ, Christophsbad Asylum Report, 1878. G. SPIES, Zur Casuistik der Traumatischen Manie, 1869. OTHER PRIMARY MENTAL DISPOSITIONS 183 ROSENTHAL, Uber Magen Neurosen, 1886. MONRO, Morbid Anatomy of the Stomach, etc. BLEYNIE, Dissertation sur I' Inflammation du Cerveau. H. VOPPEL, two cases. Allg. Zeitschrift fiir Psychiatric, vol. xiv. C. P. JOHNSON, American Journal of Insanity, 1858. MORTIMER, Philosophical Transactions, vol. xiii. KENNETH M'LEOD. Journal of Mental Science, 1861. W. J. MICKLE, ibidem, 1885. B. B. FOX, ibidem, 1891. F. LALLE^MAND, Recherches anat-path. sur I'Encephale, 1830. J. P. FALRET, Bulletins de la Societe Anat. de Paris, vol. xii. Sir THOMAS SMITH, Lancet, 1879 ; and another case, Clinical Society's Transactions, 1897. E. V. LEVINGE, British Medical Journal, 1878. F. C. WALLIS, ibidem, 1897. W. H. BENNETT, Clinical Society's Transactions, 1897. W. S. COLEMAN, ibidem, 1897. KINGSTON FOWLER, ibidem, 1897, HOARDING PROPENSITY AND ITS CEREBRAL ORIGIN Love of possession is a natural disposition implanted in the human organisation. In order to preserve existence certain animals and man store up things for future use. The desire to acquire property varies in strength in different people ; and, like other propensities, it is liable to become morbidly exaggerated to cupidity, greed, miserhness, and kleptomania. The hoarding instinct in man has become greatly changed through the substitution of money, and can be seen only, in its primitive form, in those in whom the intellect is undeveloped — i.e., in infants, idiots, and imbeciles, or where the intellect and the moral sense are in temporary abeyance, as in insanity. The impulse to acquire and hoard — kleptomania — is of most frequent occurrence in the weak-minded, who steal v^dthout reflection and merely to satisfy their animal instinct. They will purloin whatever takes their fancy. Sometimes they display a considerable amount of ingenuity and low cunning in their methods of procedure. Acts of steahng occur also in the initiatory stages of general paralysis and sometimes in the later stages as well. The patients steal under the delusion that everything they see belongs to them. They appropriate all sorts of articles, hoard and conceal them, and immediately afterwards lose aU recollection of them. Theft may also be the unconscious act of an epileptic. Cases of pure kleptomania, not complicated with any other disorder, occur more in private than in asylum practice, hence there are few cases ofificially recorded where a post-mortem examination has been under- taken to determine the seat of the lesion. According to the evidence about to be cited, the probable seat of the lesion seems to be the upper anterior part of the temporal lobe. But it has to be admitted that the evidence is so meagre, that the locahsation must be considered highly problematical. Morbid Love of Hoarding arising from an Injury to the Head. CESARE LOMBROSO (" Archivio di Psichiatria," 1882) : The patient, age sixty-four, a rich citizen, was renowned for his sordid avarice. He was found to have an immense inclination to theft. He kept a set of burglary instruments, by means of which he robbed not only his servants, whom he frequently changed, but the guest whom he invited to his house and entertained there. The proceeds of his robberies he sold. This man fell, when a boy eight years of age, from a height on to a stove, and injured his left temple. He lost his left eye through the accident, and the temple bulged for ever afterwards. Lorabroso held that this injury had caused changes in the brain which produced the morbid incUnation. Here would have been a case for the surgeon. i84 THE MENTAL FUNCTIONS OF THE BRAIN A Medico-Legal Case. ZIERL (" Friedreich's Blatter f. Gerichtl. Medizin," 1882) : L., age thirty-four, was wounded in the left temple in the war of 1870. The wound healed only after a year. There was a depression in the bone to which the superficial tissues were adherent, which became tender on pressure and in changes of weather. Patient, who was previously mentally sound and honest, had a delusion that everything he saw belonged to him. He had been sentenced eleven times before for appropriating other people's goods. On the twelfth occasion he was sent to the asylum for observation, where paroxysms of irascibility were noticed, which were accompanied by the delusion that everything he saw belonged to him. Acting on this delusion, he had kept other people's property, and hence the numerous committals for embezzlement. He was declared not guilty, as suffering from kleptomania. A Case with a Post Mortem. LUDWIG MEYER (" Archiv f. Psychiatric," 1872) : Wilhelm H., a stonemason, age thirty-three, overworked himself, being anxious, as he said, to save some money for his children. One day, after a prolonged ex- posure to the sun's heat, he fainted and afterwards became irascible. Simul- taneously he developed a delusion that he might starve, and to save himself he often asked excessive wages for his work, but inasmuch as the results of his work only deteriorated, he was discharged. He then went out thieving. For some days he stole loads of fish, at other times cartloads of wood. At the institution he loved playing at cards, but was only pleased when he could win. He died of an apoplectic stroke. Post mortem, a cyst was found in the anterior part of the left temporal lobe. Head Injury leading to Kleptomania. R. V. KRAFFT-EBING (" Uber die durch Gehirnerschiitterung und Kopfver- letzung hervorgerufenen psychischen Krankheiten," 1868) gives a number of such cases, of which the following is an example : C. D., age thirty-nine, labourer, single, hitherto healthy, who had fallen over a staircase and had knocked his head on the right temple so hard that he remained unconscious for some time. Apart from the local swelling, there were no signs or symptoms, and patient quickly recovered. Soon, however, he developed two morbid tendencies, for which he was sent to the asylum two years after — klepto- mania and voraciousness. He could not distinguish what was his own and what was other people's property. He showed some maniacal excitement occasionally only ; as a rule he was quiet. The kleptomania continued up to his death, four years after the accident. WM. JULIUS MICKLE (" Journal of Mental Science," 1885) : J. W. T., age forty-seven, married, had sustained a very severe blow on the head from a stone nearly two years previous to admission. The place struck was in front and slightly above the left ear. Patient became subject to delusions about money, and would secrete trifUng objects about the house and fill his pockets with coke. Post mortem was found decortication and adhesion of the left temporal lobe. Other Examples : KENNETH M'LEOD, two cases. Journal of Mental Science, 1861. J. CHRISTIAN, Archives de Neurologie, 1880. Sir THOMAS SMITH, Lancet, 1879. E. KLEBS, Vierteljahrschrift f. prakt. Heilkunde, 1887. WARREN L. BABCOCK, State Hospitals' Bulletin, 1896. A. SPAN BOCK, Neurologisches Centralblatt, 1895. PAUL GUDER, Geistesstorungen nach Kopfverl., 1896. F. L. A. KELP, Deutsches Archiv f. Klin. Medizin, 1872. CLOVIS GALLOPIN, Annales Medico-Psycho logiques, 1879. OTHER PRIMARY MENTAL DISPOSITIONS 185 A. KOHLER, Allg. Zeitschrift f. Psychiatrie, 1877. H. KURELLA, ibidem, 1895. THE AFFECTIONS AND THEIR CEREBRAL ORIGIN The mental functions of the occipital lobes are still unknown ; nor can we throw much light on them. But from anthropological and clinical observations it would seem that they are related to the gregarious instinct, i.e., with the affections. A psychical symptom of the softening of the occipital convolutions that follows haemorrhage is emotionalism, or loss of inhibitory power over muscles that express the affective states. Women, speaking generally, are (or used to be) more emotional and less intellectual than men. In harmony with this statement is the observation that women have more brain than men posterior to the great central fissure, and less anterior to it. HERMANN WELCKER (1822-1897) found seventy-three per cent, of female skulls dolichocephalic (long-headed). RICHTER (" Virchow's Archiv," vol. cxxviii.) and BROCA confirmed the results of Welcker. According to them, it would appear that the greater length of the female head, as compared with that of the male, is due to the additional occipital length. D. J. CUNNINGHAM (1850-1909), according to Havelock Ellis, assigns to women a longer occipital lobe. Husckhe found the same. Dr. A. WEiSBACH, in his book "Der deutsche Weiberschadel," also certifies to the larger occiput of women as compared with men. CESARE LOMBROSO (1835-1909) found in female criminals a short occiput, hence brachycephalic heads, and a complete absence of affection, though their Ubido sexualis is increased. PAUL NACKE (" Archiv f. Psychiatrie," 1893), too, examined the brains of female criminals, and found that those committed for murder had a deficient occipital lobe. In the others — thieves, etc. — the occipital lobes were of normal size. MORIZ BENEDIKT (1835-1920) has described the brains of three murderesses in whom the occipital lobes were short and did not cover the cerebellum. DAVID FERRIER observed " that the only efiect after extensive destruction of these lobes on both sides in a monkey was a remarkable state of depression with refusal of food." Sensation and voluntarj' motion were unaffected. HERMANN MUNK says of a dog whose posterior lobes he destroyed : " The sight of men whom he used to greet joyfully now leaves him cold, and even the company of dogs with whom he used to play leaves him unmoved." Thus showing destruction of the gregarious instinct which gives social aft'ection. JACQUES LOEB found that after destruction of the most posterior part of the brain (occipital region) of a bitch, it lost its parental attachment and neglected its puppies directly after delivery. Monkeys, of all animals, are the first to possess distinct occipital conv^olutions ; and they are considerably larger in the female than in the male, so that it is easy to distinguish the sexes by the appearance of their brains. The female monkey, too, shows as great, if not greater, attachment to its offspring than most animals, and orphan monkeys, according to Brehm, are always adopted and carefully guarded. All that is positively known about the functions of the occipital lobes is that the calcarine region is related to the sense of sight. This relationship was known to EMIL HUSCHKE (i 797-1 858), who wrote : " The posterior lobes are no doubt in ultimate relation with the emotional Ufe and the sense of sight. No other sense organ has such an intimate connection with the tender feehngs and grief as that of the nerve of sight, the fibres of which can be traced to the convolutions of the posterior lobes. Apart from the mimicry of i86 THE MENTAL FUNCTIONS OF THE BRAIN the eye, in which all affections are most vividly reflected, weeping is the best of all proofs." With reference to clinical histories, there is this difficulty, that occipital lesions are very difficult to isolate. They involve nearly alwajrs the parietal or parieto- temporal convolutions. Nor has any attempt ever been made to differentiate the mental characteristics of occipital lesions. Therefore the cases about to be quoted are nothing more than very vague indications of possible functions of this part of the brain. Any serious inquiry would have to start without any preconception whatsoever. EXAMPLES OF LESIONS OF OCCIPITAL LOBES T. M. T. MacKENNA (Journal of Nervous and Mental Disease, 1908) : Tumour — Jealousy, delusions of unfaithfulness. WILLIAM BOYD [Journal of Mental Science, 1873) : Tumour — Insane with jealousy. T. S. CLOUSTON {ibidem. 1872) : Tumour — Loss of affection for wife and family. JANY {Centralhlatt f. Augenheilkunde, 1882) : Tumour — Excess of grief, weeping. Sir DAVID FERRIER [West Riding Lunatic Asylum Medical Reports, 1874) : Softening — Excessive cruelty to children. W. CHARLES HOOD [Journal of Physiol. Medicine, vol. xi.) : Serous infiltration — Infanticide. ERNEST BISCHOFF [Archiv f. Psychiairie, BerUn, 1899) : Atrophy^Loss of recognition of children. H. SCHULE [Sectionsergebnisse bei Geisteskrankheiten, 1874) : Yellow infiltration — Insane grief at loss of child. O. HOTZEN [Vierteljahrschrift f. Ger. Medizin) : Arrested development, cerebellum uncovered — Matricide. G. H. BERGMANN [Zeitschrift f. Psychiatric, vol. iii.) : Prominent occipital lobes, fully one inch projecting beyond cerebellum — Insane with thoughts of love. The SA!ME AUTHOR [ibidem), a second identical case. CESARE LOMBROSO [The Criminal) : Osteophites in middle fossse, arrested development of occipital lobes — Strocco, age sixteen, killed father, brother, and made an attempt to poison mother. CHARLES PHELPS [Traumatic Injuries, 1898) : Injury to occiput — Delusions of death of wife and child. S. V. CLEVENGER [Alienist and Neurologist, 1888) : Injury to occiput — Hallucinations of being with friends. CHATELIN and de MARTEL {op. cit.) observe that " nothing is known of the functions of the external convolutions " of the occipital lobe ; only the visual area in the region of the calcarine fissure is admitted. THE SEXUAL PROPENSITY AND ITS CEREBRAL ORIGIN The sexual propensity has a spinal centre and a cerebral centre. As regards the situation of the former in the lumbar enlargement of the spinal cord all physiologists are agreed. As regards the latter, modem opinion is divided, some favouring the pineal gland, others the hypophysis cerebri. But according to the very latest observations, such bodily glands as the thyroid, thymus, and suprarenal appear to be involved. The pineal gland (a structure at the base of the brain) seems to undergo some involution in adult life, the process apparently starting at about the seventh year ; but even in the aged it appears to perform some function, and not to be merely a OTHER PRIMARY MENTAL DISPOSITIONS 187 surviving remnant like the remains of the thymus. Clinical research has been devoted chiefly to tumours of this structure. Of these, approximately ten per cent, have exhibited symptoms of nutritional change, the most typical being precocity of the genital apparatus (but only in boys, not in girls) and also to some extent of the mental powers, and marked adiposity (RAYMOND and CLAUDE, " Bulletin de I'Academie de Medicine," 1910). The former is held to be associated with defect of the pineal secretion, the latter with excess of it, while total absence may give rise to a peculiar form of cachexia. The pituitary body, or hypophysis cerebri, is considered the cerebral sexual centre by others. (See ARTHUR MUNZER, " Berliner Klinische Wochenschrift," 1911.) According to AXENFELD (" Neurologisches Centralblatt," 1903), tumours of the base of the brain, especially those which involve this structure, are most commonly productive of cessation of menstruation. Persons suffering from acromegaly, due to tumours of the h3'^pophysis, are said to have complete amenorrhcea as one of its first symptoms. HARVEY GUSHING, of John Hopkins University (" Journal of Nervous and Mental Disease," 1906), called attention to cases in which tumours affecting the hypophysis were complicated not only by optic atrophy, but also by sexual infantilism, this latter condition involving complete absence of menstruation. There seems to be some antagonism between the pineal and the pituitary bodies, as removal of the testicles is said to lead to atrophy of the pineal and to hypertrophy of the pituitary. In the opinion of others, not only pituitary insufficiency, but also insufficiency of the thyroid secretion may cause the genital organs to remain infantile, and disease of these structures may cause retrogression in the genitalia even after they have functioned normally. Removal of the thyroid is said to produce an intense degree of atrophy in the uterus. The ovaries, however, do not retrogress ; on the contrary, there appears to be increased activity. The thymus gland is also mentioned in connection with this function, removal of the ovaries leading to its hypertrophy. According to the most recent investigation, yet another bodily structure appears to be involved. It is claimed that suprarenal tumours in male children are prac- tically alwaj^ associated with precocity of the sexual organs and secondary sexual characteristics ; whereas the sequence in female children is not precocity of the sexual organs, but a tendency to produce the characteristics of the male in the sexual organs, together with a deep voice. The evidence in favour of these structures, cerebral and bodily, is, however, poor compared with the evidence which Gall produced for his cerebellum theory, and which has greatly increased in the course of a century. But, it will be said at once, " Surely you do not intend to revive that long-discredited theory of Gall ? Scientific opinion is absolutely agreed that it is utter nonsense." I am fully aware that th^ mind of physiologists and neurologists is made up on this question. They have given their verdict. But I am also aware, by the abuse that is heaped upon Gall, that his evidence has never been read, and that no attention has been paid to the extra- ordinary number of clinical cases which favour his theory, and these I propose to quote for whatever they are worth. For the present I would ask the scientific expert to be indulgent, and let me restate the whole problem, not with a view to prove Gall's conception of it, but to enable future investigators to discover what is the cerebral seat of this fundamental propensity. Before doing so, let me remind the expert that the thyroid secretion has a marked influence on the intellectual and emotional manifestations ; yet he would not dream of locating these in the thyroid gland. Similarly the structures men- tioned may influence the sexual organs, and yet not be the seat of the sexual propensity. i88 THE MENTAL FUNCTIONS OF THE BRAIN At the outset, it has to be remembered that Gall was the first to describe the structure of the cerebellum, so that there can be no question of his qualification as an anatomist. Next, it has to be pointed out that all investigators have proceeded on the false assumption that Gall located in the cerebellum the sexual potency ; but he did nothing of the kind. Gall did not say that every vital function concerned in propagation depends immediately upon the cerebellum, but that the idea or feeling which prompts to the generative act is organically dependent upon it. He located only the sentiment which involves consciousness in the cerebellum. The second factor in the process, the reflex action, must take place through the agency of the appropriate segment of the spinal cord, namely the lumbar enlargement. And the last factor in the process — the secernment — may occur through the sexual organs. Therefore, to do Gall justice, we must observe whether changes in the thymus, thyroid, pineal, pituitarj^ or suprarenal glands atiect the Ubido, i.e., the psychical sexual condition. Gall located only the libido sexualis in the cerebellum, not the potentia coeundi ; and he did not locate the Hbido in the central portion of the cerebellum, but in the lateral lobes, of the functions of which — to this day — we know nothing. The lateral lobes of the cerebellum are situated in the occipital fossae, externally visible in an arch between the occipital protuberance and the mastoid processes behind the ears. The greater the size of the cerebellum, the deeper the fossae, and the more prominent these arches, the larger the surface for attachment of the muscles, making the nape of the neck rounded, large and thick. Wlaen the lateral lobes are small, the distance between the two mastoid processes is narrow ; the ears lie close together, and the nape of the neck is flat and depressed. But, of course, the size of the cerebellum must be calculated in relation to the size of the entire brain. Taken in such relation, the cerebellum in infants up to the age of puberty is small. In the human race the cerebellum is a sixteenth to a twenty-fifth part of the whole brain at birth ; but after puberty the ratio between cerebellum and cerebrum is as i : 6 or i : 7. Gall thought this was due to the development of the sexual passion, and I am not aware that any other explanation has ever been offered. Both MEYNERT and NOTHNAGEL (" Centralblatt f. Nervenheilkunde," 1878) have observed that the cerebellum increases in size accordingly as one ascends the scale of life ; and even when the cerebrum has reached its absolutely highest weight, the cerebellum continues to grow, and represents most definitely the scale of rising and decHning manhood, WTiy is this ? According to Gall, the cerebellum is relatively largest in man, whose sexual activity is not, as in the case of animals, confined to the heat periods. He claimed to have observed that castration in early infancy prevents its full development ; and that frequently the cerebellum is of excessive size in ofienders against morahty, and there is turgescence or disease in persons suffering from satyriasis or nympho- mania. He even went so far as to assert that removal of one testicle not in- frequently diminishes the size of the cerebellar lobe on the opposite side. REICHARDT (" AUg. Zeitschrift f. Psychiatric," 1906) declares this latter statement as " undebatable nonsense." He bases this very strong opinion on three cases he had observed. The first was that of a general paralytic, seventy years old, who had one testicle crushed by a waggon that went over it ; the second, a man, fifty-seven years of age, also lost a testicle through an accident ; and the third was a cretin, thirty years of age. Surely, these are not suitable cases for an investigation, neglecting the most primary precaution that the subject should not suffer from any other disease. OTHER PRIMARY MENTAL DISPOSITIONS 189 Gall further showed that when the cerebellum is inordinately developed at an early period there is precocious manifestation. He gave other cases to show the effect of emasculation on male children. If mutilated in infancy, there is no desire ; if mutilated after puberty, or at that period, the desire remains, but is feeble. Gall performed numerous dissections and experiments on animals, the results of which supported his theory. I must leave it to the expert to examine this mass of evidence. Here I can mention only a few facts. He observed an increased turgescence of the cerebellum in animals killed at the moment of heat as compared to the cerebellum of animals destroyed in another season. The emasculation of the males of our domestic quadrupeds at an early period of Ufe is stated to prevent the development of the cerebellum. Hence the smallness of the neck of the castrated horse, ox, sheep, and hog compared to that of the uncastrated one. And those that are castrated soon after birth have no sexual propensity. But in those cas- trated after maturity some share of the propensity remains, although the power of performance is taken away. And in these the cerebellum is diminished in size after castration, but never becomes so small as it would have been had they been cas- trated at an early period. Emasculation afiects materially no other portion of the brain but the cerebellum. The effects of early and late castration on the potency of men were known to the ancients. For this reason Roman women deferred the period of castration until their slaves had passed the age of puberty, and were thus able to satisfy their passions without danger. " Sunt quas eunuchi imbelles, ac mollia semper oscula delectant, et desperatio barbcs, et quod abortivo non opus est," etc. — Juvenal, Sat. vi. Gall and his followers furnished a number of pathological observations of lesions of the cerebellum, especially of injuries, and showed that when the cerebellum is concussed or atrophies, the libido is extinguished ; when the injury inflames the cerebellum, the libido is rendered more intense. Still, it must be admitted that Gall made most of his observations on the living subject, judging the size of the cerebellum by the size of the nape of the neck. Therefore, even if Gall was correct in his observation, he may have been wrong in his inference. A large nape of the neck may mean a large occiput, but it does not necessarily mean a large cerebellum. The nape of the neck may be large in consequence of the development of the under- surface of the occipital lobes, and only in a minor degree, if at all, indicate the size of the cerebellum. That a large nape of the neck indicates an active sexual propensity can be verified by observations both on men and animals. I believe agriculturists are well aware of it. In this connection I may relate the visit of the celebrated Dr. F^LIX VOISIN to Toulon Prison to study the heads of men confined for crimes on women. He was expected to select them out of 372 prisoners of all sorts. He chose 22 in- dividuals, and did not look at the rest. Thirteen of these had actually been con- demned for rape ; the other nine were committed for other crimes, but were under special surveillance for sexual procUvities. (" De I'Homme Animal," Paris, 1839.) In the course of my medical practice, a number of children have been brought before me, both boys and girls, some as young as four years of age, manifesting sexual precocity. In all of them I have found a very large occiput, ordinary in length, i.e., not elongated, but extraordinary in mdth at the nape of the neck from ear to ear. I have observed the same formation in adults for whom the opposite sex had an excessive attraction, amounting in some to a mental obsession. This peculiarity is particularly noticeable in old men who have not given up courting. Maybe that this observation, which can be easily verified, is of no more than physiognomical significance ; but I mention it as confirming Gall's view. igo THE MENTAL FUNCTIONS OF THE BRAIN HENRY HEAD (" Brain," 1894) finds that the pain and tenderness in diseases of the ovaries or testes is referred to the occiput. The nape of the neck covers the cervical vertebrae, and it is a common observation that injury to these may cause priapism. MARSHALL HALL (" Lancet," 1838) wrote : " I have never met with any case in which priapism took place, except when the cervical spine was the seat of injury. Whenever the cervical vertebrae have been injured priapism has almost invariably occurred immediately after the injury." This is known to those who have observed " hanging by the neck." T. SYMES PRIDEAUX wrote : " The convexity of the lower fossae of the occipital bone and their protrusion backwards and downwards really have a connection with the strength of the sexual feeling ; but then these conditions are principally due to the development of the under surface of the posterior lobe of the cerebrum, and but in a minor degree to the size of the cerebellum." That the ancients observed the size of the nape of the neck appears from their nuptial ceremonial. It was customary to measure the neck of the virgin previous to the wedding, and again on the following day, and if it had increased it was a sign that marital relations had taken place. This curious test, which has also been utilised to estabUsh the fact of adultery, has been transmitted to us in the Epithalamium of CATULLUS : " NoH illam nutrix orienti, luce revisens, Hesterno collum potuit circumdare filo." ApoUonius of Rhodes, speaking of the passionate love of Medea, sa^"^ : "The fire which devours her attacks all her nerves and makes itself felt behind tlie head in that spot where pain is most poignant when an extreme fervour seizes all the senses." Of olden time, artists depicted broad necks for sensual people. Since Gall's time numerous experiments have been performed on animals, all apparently disproving his theory, and their authors vie with each other in heaping contumely on poor Gall, that " idiot," in the opinion of KONRAD RIEGER. Still I ask the expert to read these pages patiently to the finish. If his mind is not already made up, he may learn something that may prove of advantage to him in attempting to solve the problem. Remembering Flourens' experiments, which delayed the recognition of the localisation theory for half a century, would it not be wise to reserve judgment until we have a larger store of facts from which to draw our deductions ? From the history of the numerous investigations into the functions of the cerebellum which are about to be given, it will be seen that most authors are agreed that this structure is the centre of co-ordination and preservation of the equiUbrium of the body. This does not, of course, exclude the possibihty of its being the centre of the Ubido as well. But regarded purely as a regulator for movement, why does it develop so late in children ? Co-ordination and equilibrium are established before puberty. Why does the cerebellum bear no relation to the locomotor capacities of animals ? \\Tiy is manual dexterity not afiected by a lesion of the cerebellum ? It will be seen that some physiologists are against Gall's theory, because faradisa- tion of the cerebellum failed to excite the sexual organs. But Gall did not locate the potentia there, but merely the desire. We might as well expect that faradisation of the left third frontal convolution — the speech centre — should make a man talk. We do not excite the stomach by exciting the gustatory centre. The great majority of the physiologists are sure of the utter worthlessness of Gall's view because destruction of the cerebellum not only keeps the sexual instinct intact, but seems to excite it. Now, destruction, especially by slow ablation, is bound to act as an irritant, and, secondly, the destruction is probably hardly ever OTHER PRIMARY MENTAL DISPOSITIONS 191 complete, for as RISIEN RUSSELL (" Philosophical Transactions," 1894) has pointed out, as the result of his experimental researches into the functions of the cerebellum, the destruction of the entire organ is a surgical interference of such magnitude that nearly all the animals experimented on succumb to the immediate consequences of the operation. Even were sexual potency — and not the Ubido — located in the cerebellum, it would be no more surprising that destruction of this organ shows no loss of the particular function, than that movements are preserved after the entire cerebral motor area has been removed. Gall's follower, BOUILLAUD (i 796-1881), "Archives Centrales de Medecine " (1827), did not accept the locaUsation. He thought the sexual instinct was located in the medulla. THOMAS WILLIS (1622-1675) held the cerebellum to be the source of all in- voluntary movements, especially of respiration, heart, and bowels. LUIGI ROLANDO (1773-1831), as a result of his experiments, regarded the cerebellum as the central source of all voluntary movements. F. MAGENDIE (1783-1855), "Lectures on the Physiology of the Nervous System," noticed the extreme difi&cultyof making a conclusive experiment on the cerebellum, and thought it the seat of a propensity to move " forwards," opposed by a propensity to move " backwards," with its seat in the corpora striata. Still, he acknowledged that he was struck to find so many cases of high irritation of the genital apparatus coinciding with atrophy or more or less destruction of the cerebellum. JULIUS BUDGE ("Researches of the Nervous System," Frankfort, 1841), VALENTIN, HAMMOND, and SPIEGELBERG saw in the cerebellum an apparatus for the inhibition of motion, and observed after stimulation movements of the uterus and testicles. J. P. FLOURENS (1794-1867) stated that on removing the first layers of the cerebellum in the pigeon or guinea-pig, for instance, weakness and hesitation in walking were produced. When the middle layers were cut out, the animal staggered much, but heard and saw perfectly, and did not express pain. When the whole cerebellum was removed, an inability to fly, walk, or run took place, and the animal lay down ; whence he inferred that the cerebellum is the organ by which all the locomotive actions are regulated. F. LEURET (1797-1851), "Anatomic Comparee du Systeme Nerveux," 1839, made many investigations to disprove Gall's theory, that castration before puberty causes arrest of development of the cerebellum. He weighed the organ, whereas Gall measured its size. Now, it is quite possible that the size of a cerebral organ may diminish without its weight diminishing ; the size may even diminish and the weight increase, as in sclerosis. Leuret thus found the cerebellum in castrated horses rather heavier in weight than normal ones. On the other hand, HUSCHKE (" Schadel, Hirn u. Seele," Jena, 1854) contradicts Leuret, and says that castration in animals has very detrimental efiects on the occipital brain (cerebellum, pons, and medulla), which assumes infantile appearance. Sir DAVID FERRIER ("The Functions of the Brain," London, 1876) considers the cerebellum an organ of " equilibration." He thinks that after destruction of the cerebellum the animal has still sexual desires, but fails to execute them on account of its defective control over its limbs, so that it must be put in the necessary position. Nor will the animal seek gratification voluntarily. Still, Ferrier does not seem opposed to Gall's view, for he says (" Functions of the Brain," p. 432) : " As morbid irritation of the sexual organs may excite a morbid sexual appetite, so, conversely, the sexual appetite may be morbidly excited by pathological irritation of the cerebral paths and the cerebral centres of the sensations connected with the exercise of the generative functions. To the former belong the satyriasis or nymphomania occasionally observed in connection with disease of the middle lobe of the cere- bellum ; to the latter the various morbid exhibitions of the sexual appetite in insanity where the centres are functionally or organically diseased." On p. 123 he explains, however, that " disease of the median lobe of the cerebellum has been found to co-exist with priapism, or excitement of the generative organs," but that 192 THE MENTAL FUNCTIONS OF THE BRAIN " such a condition of things is eminently calculated to cause irritation of the sub- jacent posterior surface of the medulla oblongata and pons." Sir VICTOR HORSLEY (i 857-1 91 6) has shown by his experiments that, unless the cerebellum is intact, running, walking, and even standing, are impossible. The automatic function of standing involves extension, of which the newly-born of most mammals are incapable. But standing does not depend entirely on the cerebellum. There are other centres concerned in this. The cerebellum is not even the centre for equihbration. This is in the labyrinth and semi-circular canals of the ear. The tendency in cerebellar disease to incline the head to the side of the lesion is, I beheve, due to lesions of the labyrinth. It is the middle portion of the cerebellum — the vermis — only which is connected with disturbances of movement ; the functions of the lateral lobes are still unknown. According to W. WUNDT (1832-1920), " the cerebellum appears to be intended for the direct regulation of voluntary movements by sense impressions. ... If this hypothesis be correct, it will, accordingly, be the central organ in which the bodily movements incited from the cerebrum are brought into harmony with the position of the animal body in space." F. L. GOLTZ (1834-1902) destroyed the middle lobe of the cerebellum, and found the sexual functions still intact. This is quite natural, for lesions of the middle lobe were known to Gall to cause inco-ordination of movement. Goltz did not destroy the lateral lobes, and his experiment diminishes in value in the face of another which he performed, dividing the spinal cord in the lumbar region opposite the first lumbar vertebra, when the function, as he says, was also still preserved. This agrees with the observation of W. B. CARPENTER (1813-1885), who performed the same experiment of section of the lumbar cord. Clinical observation, however, has shown opposite results. In transverse lesions of the lumbar region of the cord, impotency is common. LUIGI LUCIANI (1842-1919), " II Cerveletto," extirpated one half of the cere- bellum in bitches. The animals manifested " heat " at the usual period, though the act could not be effected owing to motor instability. Why should they not manifest heat if the lumbar centres were intact ? He also deprived a dog of the entire cerebellum, and the mutilated male and female animals exhibited such sexual eagerness " that my laboratory seemed to be transformed into a lying-in hospital." The possibility that the mutilation set up inflammation, which acted as an irritant, occurred to Luciani, only that he thinks that owing to destruction of the cerebellum " some inhibitory factor had dropped out, causing an abandonment to fleshly lusts." This agrees with CARL OTTO (i 795-1 879), who regarded the cerebellum as an inhibitory apparatus for the sexual instinct. (" Centralblatt f. Nervenheil- kunde," 1877.) According to Luciani, after cerebellar lesions, the movements lack their normal energy, the tonus of the muscles is lowered, and the movements are uncertain and incoherent. He is inclined to regard the cerebellum as primarily an apparatus for the production of nervous force, an " auxiliary " or " intensificatory system " for the whole cerebro-spinal organ, which is not the seat of any specific or peculiar functions, but reinforces the functional activity of the entire nervous system. In support of this view, he adduces the trophic disturbances that appear, in course of time, more especially after complete extirpation of the cerebellum. PH. LUSSANA (1820-1898), " Fisiologia a Patologia del Cerveletto," Verona- Padua, 1885, thought the observations of cerebellar lesions have not been conducted with sufficient care, and cited thirty-five cases with affection of sexual " sensation " (senso specifico venereo). The sexual propensity (instincto venerio) which gives the impulse to seek connection he located in the cerebrum. The abuse of the sexual instinct he believed to produce a particular form of vertig. ataxy. It has an efiect on the co-ordination of movement. The effect of over-indulgence must be studied pathologically and cannot be determined by experiment. As is well known, in the initial stages of locomotor ataxia there is frequently a hyperactivity of the sexual instinct, which afterwards becomes extinguished. We might therefore expect, in addition to the spinal lesion, changes in the cerebellum. These morbid changes in the cerebellum of ataxic patients have been described by ERNST JENDRASSIK (" Deutsches Archiv f. Klinische Medizin," 1888). He OTHER PRIMARY MENTAL DISPOSITIONS 193 gives illustrations of the atrophy of the cells. Anaesthesia and analgesia of the genitals was found by Fournier, G. E. Riviere (Bordeaux), 6mile Bitot and Jean Sarrazes {" Revue de Medecine," 1891), and Marinesco (" La Semaine Medicale," 1897). It is also known that sexual excess is a common symptom in the early stages of general paralysis (Voisin drew attention to the fact), and J. LUYS (" Recherches sur le Systenie Nerveux Cerebro-Spinal ") states that in all the autopsies of cases of general paralysis which he had made he had found the grey substance of the cere- bellum to be diseased in a more advanced degree than the cerebral convolutions. ADOLF MEYER (" Archiv f. Psychiatrie," 1889) showed atrophy of the cerebellum in general paral^'^is, in the form of a sclerosis. JELLINEK described the microscopical appearances of atrophy of the cerebellum in Tabes Dorsalis. WILLIAM P. KROHN (" Journal of Nervous and Mental Disease," 1892) observed sexual incompetency and ataxy in a cat whose cerebellum was subsequently found uniformly atrophied. A minute histological description was given. F. A. LONGET (1811-1871), " Anatomic et Physiologie," vol. i., and HEUSINGER found haemorrhage in the cerebellum with swollen, inflamed testicles. F. COURMOUL (" Le Cervelet et ses Fonctions," Paris, 1891) regarded the cere- bellum as a psychic and sensitive organ. ANDRI THOMAS (" Le Cervelet," Paris, 1897) regarded it as an organ of sensation. The sensation of the generative organs is lost in lesions of the cerebellum. Sir JAMES CR ICHTON-BROWNE (" West Riding Lunatic Asylum Medical Reports," vol. ii.) said : " The exact functions of so large and important an organ as the cerebellum are still undecided, but most authorities incline to the belief that it is in some way connected with the genital system, and is the seat either as a whole or in part of the sexual instinct or of the sexual sensation. When so accomplished a physiologist as Dr. Carpenter, who will certainly not be suspected of any phrenological bias, is found supporting the latter view, and when Brown-Sequard is found corroborating it, and attributing to irritation of the cerebellum an exaggeration of the sexual desires, there can be little hesitation in accepting it as true in the main, but as subject to qualification hereafter in accordance with the increased accuracy of our knowledge of the nervous centres. The effects of injuries in the region of the cerebellum are strongly confirmatory of the opinion that it is in intimate relation with the sexual appetite and apparatus." CESARE LOMBROSO (1835-1909), in his work, " The Female Offender," said that " female criminals who have a large cerebellar development have no chastity." ENRICO ROSSI (" II Manicomio Moderno," 1891) opposed Longet's and Luciani's views and regarded the cerebellum as the organ of the sexual instinct. HENRY POWER ("Human Physiology," London, 1881) and AUSTIN FLINT (" The Physiology of Man," New York, 1873), also support the cerebellar theory. The former quotes Brown-Sequard and also Carpenter, who pubUshed seven clinical cases of cerebellar lesions in sexual cases. R. JAMESON (" Journal of Mental Science," vol. xxii.) located the amative pro- pensity in the cerebellum and considered deficiency in its size a cause of anaphrodisia. CHATELIN and de M ARTEL {op. cit.) say with reference to the cerebellum that " it would be of little use to recount in detail the complicated history of the almost useless experiments on animals carried out in former days." They rely on BARANY'S clinical researches, which appear to prove in the cerebellar cortex (four) centres of mtiscular tonicity, which furnish the groups of muscles of the various joints and maintain their attitude in repose by balancing the antagonistic muscles. I shall now produce an extraordinary number of clinical cases — extraordinary in view of the fact that the sexual function is so seldom inquired into in cases of cerebral lesions, and that the cerebellum is so seldom examined at autopsies. All we know of the functions of the cerebellum is that the central portion has to do with inco-ordination (cerebellar ataxy), and that extensive and even gross destruction of the lateral lobes may take place without producing any obvious symptom. We have Vol. ii.] o 194 THE MENTAL FUNCTIONS OF THE BRAIN shown that phj^iologists ascribe to the cerebellum no mental function whatsoever, and that they consider as exploded the antiquated theory of its relation to libido sexuaUs. But that there is, in addition to the subsidiary lumbar centre, such a centre somewhere in the brain — and probably adjoined to the cerebellum, if not in the cerebellum itself — can no longer be doubted. For this reason I have repro- duced the clinical histories which favour this theory, and we may hope that some investigator may sooner or later discover the actual localisation of this — one of the most primary propensities. I need only add that, with the exception of Gall's contemporaries, the authors mentioned in the succeeding pages had no theory to sustain. They faithfully reported the cases they had witnessed. The cerebellum receives httle or no attention in normal people. Almost all the cases of arrested development which have been recorded have been observed in idiots and imbeciles. Not only is there arrested development of the cerebellum, but the genital organs are also frequently undeveloped. FELIX VOISIN (1794-1872) noticed this in 150 idiots and imbecile girls at the Salpetriere ; and BOURNEVILLE and SOLLIER (" Le Progres Medicale," 1888) found 554 per cent, of idiots under thirteen years of age with anomalies of the sexual organs. GALL, as already mentioned, cited numerous clinical examples. Baron LARREY (1766-1842), Napoleon's mihtary surgeon-in-chief, in his book on " Observations on Wounds," quoted quite a number of cases of his own experience. E. R. A. SERRES (1787-1868), " Journal de Physiologic," Paris, 1822, who was physician to the Hopital de la Pitie at Paris, and whose hostility to Gall is scarcely less known than his anatomical researches, claimed to have found undeniable evidence of the sexual functions of the cerebellum. He published a number of cases of cerebellar apoplexy which had come under his notice, and which all occurred in persons while they had abandoned themselves to venereal excesses, and in all of them he found an inflamed state of the cerebellum. Why is there no surgeon at the present day who will test the validity of this evidence ? We read now and then of such cases, but never that the cerebellum has been examined. The fact is, men only look where they expect to see something ; and since " their mind is made up " that there can be no cerebellar lesion, they do not look for it. But, even if they merely disproved Gall's theory, their evidence would be of value. G. ANDRAL (1797-1876) and P. S. SEGALAS (1792-1875) cited a number of examples. COMBETTE ("Revue Medicale," 1831, also quoted in Longet's "Anatomic et Physiologic du Systeme Nerveux," 1842) published the well-known case of the girl Alexandrine Labrosse, addicted to perversion from infancy, who was found, on post- mortem examination, to have no cerebellum, owing to atrophy. She could co- ordinate all the limbs voluntarily, and had the full use of all the senses. She was, however, subject to falling, and spoke imperfectly. Sir ALEXANDER MORISON (1779-1866), in his "Lectures on Insanity " (1848), pubhshed several cases, of which the following is an example : Robert S., imprisoned in Horsemonger Lane Gaol for attempting to gratify his unnatural propensities, which he indulged in from his early youth and for which he had been sentenced on three previous occasions, was found, post mortem, to have a large ulcer in the cerebellum. C. F. BURDACH (1776-1847), the celebrated physiologist, produced also in his book, " Vom Bau und Leben des Gehirns," quite a number of such cases. JOHN EPPS (1805-1869), " Lancet," 1828, brought before the Westminster Medical Society two cases, one of nymphomania, one of satyriasis, both suffering from extensive disease of the cerebellum. WM. A. HAMMOND (1828-1900), " Quarterly Journal of Psychological Medicine," vol. iii., published three cases. W. B. CARPENTER (1813-1885), in his " Human Physiology " (1881), as ahready mentioned, published seven cases. A. OTTO (" Centralblatt f. Nervenheilkunde," 1877) produced four cases. PH. LUSSANA (1820-1898), in his " Fisioiogia e Patologia del Cerveletto " (1885), published not less than thirty-five cases. OTHER PRIMARY MENTAL DISPOSITIONS 195 MORIZ BENEDIKT ("Archives de I'Anthropologie Criminelle," 1891) performed the post mortem on Hugo Schenk, whose trial at the time caused a great sensation in Vienna. He formed an extraordinary number of Uaisons with servant-girls, and when he grew tired of them, which was usually very soon, he murdered them. He was handsome, very intelligent, and an excellent talker. His sexual vigour was extraordinary, and, being of a lazy disposition, he exercised it for a Uving. He was executed at the age of thirty-six. Post mortem it was found that his cerebellum was of extraordinary weight, namely 194 grammes, i.e., over twenty-five per cent, above the normal. GIUSEPPE MAINARDI (" AUg. Zeitschrift f. Psychiatrie," 1873) observed a similar case of a satyriacal maniac and wholesale murderer — Giovanni Grassi — in whom he found, post mortem, inflammatory lesion of the cerebellum. I could go on giving a hundred more such cases with their unwholesome details, but this being a general and not exclusively a medical work, I shall give merely a classification and the necessary references, for the investigation by experts who wish to take up this problem. The following is the report of a case of cerebellar tumour which was sent to me from a North Country institution, with the request that, " if the notes forwarded to you are pubhshed, would you be good enough to suppress any reference to this asylum ? " T. N., age forty-seven, married, was admitted to the asylum, with all the physical signs of general paralysis except the speech, which was clear, with delusions of great wealth, but otherwise clear intellect until his death six months later. The following history was suppUed by the wife to the medical superintendent : " She had been married to the patient nineteen years. She had one child ; no mis- carriages. He had connection two or three times a week throughout their married life, yet he went with other women, and used to masturbate, having previously made ' soap women,' which he put on the bed. He had a good tenor voice, drank freely, was not specially extravagant, and when sober was a hard-working man. Three weeks before admission the first signs of illness developed." The following notes were made at the autopsy. " The cerebrum was normal. The membranes stripped readily, and the arachnoid showed no opacity. Weight of encephalon 1345 grammes ; of Pons Varohi, 20 grammes, medulla 9 grammes, and cerebellum 150 grammes. In connection with the cerebellum, there was a small growth of about the size of a filbert ; it was of a whitish colour and consisted of numerous small nodules, somewhat resembling small sago grains ; it sprang from the membranes, and was removed easily and without in any way damaging the cerebellar cortex. It w^as situated on the under surface of the cerebellum, and could not be well seen until the medulla was removed. It arose from the membranes in the slight recess situated between the uvula and amygdala of the right side, and pressed on and slightly indented the right lobe of the cerebellum, and the uvula was pushed slightly to the left. There was no sign of any vascular disturbance around, and beyond the fact that some portion of the cerebellum was apparently pushed slightly out of position, there was no other change visible. The post mortem otherwise showed only some slight renal cirrhosis." The writer adds : " We have no pathological laboratory at the asylum, that is why the growth was not examined microscopically." Examples of PRIAPISM in Cerebellar TUMOURS, producing congestion : N. FRIEDREICH, Intracranial Tumours, 1853. PERSILLE, Oppenheim's Zeitschrift, 1849. JOHN ELLIOTSON, two cases. Lancet, 1837. RIFFORTZ, Journal f. Chirurgie, vol. xxiii. K. F. H. I^BIERIIANN, Berliner Klinische Wochenschrift, 1865. PfiGOT, Archives Gen. de Medecine, 1834. G. ANDRAL, ibidem. MIGNOT, Gazette Hebdomadaire, 1875. 196 THE MENTAL FUNCTIONS OF THE BRAIN E. R. A. SERRES, Journal de Physiologic Experimentale, 1828. Also Mance, Dubois, Falret, Dunglison (mentioned by Burdach), etc. Examples of PRIAPISM with other Cerebellar LESIONS: J. B. F. GIRARDIN, haemorrhage. Journal de Physiologic, 1882. C. GUIOT, haemorrhage. Clinique des Hdpitaux, vol. i. WILLIAM STOKES, haemorrhage. London Medical and Surgical Journal, vol. v. R. DUNGLISON, inflammation. London Medical Repository, vol. i. H. DEMME, bullet wound. Militdr-Chirurg. Studien, 1864. E. R. A. SERRES, inflammation and haemorrhage. Journal de Physiologic Exp., 1828. Six cases. Examples of SATYRIASIS with Cerebellar TUMOURS causing Congestion: MARTINEAU, Bulletins de la Soc. Anat., 1859. BORDIER, ibidem, 1865. JOHN D. FISHER, man, age seventy-three. American Journal of Medical Sciences, vol. xxiii. JOHN ELLIOTSON, Lancet, 1837. Examples of SATYRIASIS with other Cerebellar LESIONS : HOSPITAL, inflammation. Annales Medico-PsychoL, 1875. CAFFORT, inflammation. Archives Gen. de Medecine, 1830. ROBERT BIANCHI, inflammation. Lancet, 1855. ROBERT DUNN, inflammation. Medico-Chir. Transactions, 1849. H. SCHULE, inflammation. Sectionsergeb. b. Geisteskranken, 1874. A. W. FOOT, tubercular disease. Dublin Journal of Medical Science, 1872, BOTTENTUIT, haemorrhage. Bulletins de la Soc. Anat., 1869. Sir JAMES CRICHTON BROWNE, injury. West Riding Lunatic Asylum Medical Reports, vol. ii. FRANCIS SKAE, injury. Edinburgh Medical Journal, vol. xi. E. ROSSI, II Manicomio, 1891. A. OTTO, Archiv f. Psychiatric, 1874. Examples of NYMPHOMANIA in Cerebellar TUMOURS causing Congestion : EISENSCHtJTZ, girl, age eight. Jahrbuch f. Kinder heilkunde, 1868. W. EBSTEIN, prostitute, Virchow's Archiv, vol. xliv. BENNETT, girl, age eleven. Gazette Medicale, 1834. SCZYPIOVSKI, Thhe de Paris, 1890. M. JASTROWITZ, Deutsche Mediz. Wochenschrift, 1888. STEINER, Wiener Medizin. Wochenschrift, 1870. J. S. BRISTOWE, girl, age twenty. Brain, 1884. Examples of NYMPHOMANIA with other Cerebellar LESIONS : M. JASTROWITZ, inflammation. Lokalisation im Gehirn, 1888. PA YEN, inflammation. Essais sur L'Encephalite, 1826. G. FOSSATI, abscess. Journal de Phren., vol. v. S. W. B. WILLIAMS, prostitute, softening. Journal of Mental Science, 1869. GUSTAV SPIES, hyperaemia. Traumatische Manie, 1869. FR. MESCHEDE, inflammation. Allg. Zeitschrift f. Psychiatric, 1873. E. HITZIG, suppuration, no inco-ordination. Archiv f. Psychiatric, 1884. F. MAGENDIE, Lancet. 1837. Examples of SEXUAL EXCITEMENT, Obscene Acts, Disgusting Language, etc. : P. W. MacDONALD, woman, eighty-nine. Brain. 1890. GUSTAV SPIES, hyperaemia. Zur Casuistik d. Traum. Manie, 1869. M. SOMMER, injury. Monatsschrift f. Psychiatric, vol. xxii. CLOVIS GALLOPIN, inflammation. Annales Me'dico-Psychologiques, 1879. OTHER PRIMARY MENTAL DISPOSITIONS i